Obsesif Kompulsif Bozuklukta; Klasik Bilişsel Davranışçı Terapi ve Yeni Nesil Kabul ve Kararlılık Terapisi, Karşılaştırmalı Müdahale Yaklaşımları

Yıl 2024, Cilt: 7 Sayı: 13, 45 - 61, 30.01.2024

Ayşin Akdağ

https://doi.org/10.56955/bpd.1370907

Öz

Obsesif Kompulsif Bozukluk (OKB), bireylerin yaşamlarını ve hayata dair yaşamsal işlevlerini farklı düzeylerde olumsuz etkileyen bir düşünce bozukluğudur. Bu derlemede, OKB' nin anlaşılması ve tedavisinde, klasik Bilişsel Davranışçı Terapi (BDT) ile BDT temelli yeni nesil çağdaş terapilerden Kabul ve Kararlılık Terapisi (KKT)’ nin temel özellikleri ve müdahalelerinin karşılaştırmalı gözden geçirilmesi amaçlanmıştır. Bu amaçla alanyazın incelenerek bu derleme yazılmıştır. Derlemede OKB’ nin tanımı ve yaygınlığına değinilmiş olup, OKB’ nin oluşumuna dair, birinci kuşak Davranışçı Terapi, ikinci kuşak Bilişsel Terapi ve yeni nesil /3.Kuşak terapi kuramlarından Kabul ve Kararlılık Terapisi (KKT)’ nin açıklamalarına ve kuramların karşılaştırmalı etkinlik araştırmalarına yer verilmiştir. OKB’ nin tedavisinde, birinci ve ikinci kuşağın bir arada ifade edildiği Klasik Bilişsel Davranışçı Terapi (BDT)’ de başat davranışçı teknik Maruz Bırakma ve Tepki Önleme (MBTÖ) , bilişsel müdahaleler için bilişsel çarpıtmalar, abartılmış sorumluluk, Düşünce Eylem Kaynaşma (DEK) ile ilişkili bilişsel yeniden yapılandırma çalışmaları ele alınmıştır. Kabul ve Kararlılık Terapisi (KKT), İlişkisel Çerçeve Kuramını esas alarak, bağlamsal zeminde altı psikolojik süreci kullanmaktadır. Bunlar; kabul, bilişsel ayrışma, bağlamsal benlik, şimdiki an ile temas, değerler, taahüt edilen eylemlerdir. KKT, klinik düzeyde sorunlu davranışları sadece biçimsel yönleriyle değil bunların işlevsel yönleriyle de ele alarak tedaviye yeni bir felsefi ve hümanistik yaklaşım sunar. Bu nedenle de bireye özel uygulamalar içerir. KKT’ inde terapist, BDT’de olduğu öğretici ve rehber konumundan, eşlik eden, bireye hayatının dümeninin kendinde olduğunu fark ettiren, bireyi tedaviye davet eden pozisyonda yer alır.

Anahtar Kelimeler

Obesesif Kompulsif Bozukluk, Bilişsel Davranışçı Terapi, Bilişsel Terapi, Davranışçı Terapi, Kabul ve Kararlılık Terapisi

Classical Cognitive Behavioral Therapy and New Generation Acceptance and Commitment Therapy, Comparative Intervention Approaches in Obsessive Compulsive Disorder

Öz

Obsessive Compulsive Disorder (OCD) is a thought disorder that negatively affects individuals' lives and vital functions at different levels. In this review, it is aimed to provide a comparative review of the basic features and interventions of classical Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT), one of the new generation contemporary therapies based on CBT, in the understanding and treatment of OCD. For this purpose, this review was written by reviewing the literature. In the review, the definition and prevalence of OCD are mentioned, and the explanations of first generation Behavioral Therapy, second generation Cognitive Therapy and Acceptance and Commitment Therapy (ACT) from the new generation / 3rd generation therapy theories and comparative effectiveness studies of the theories are included. In the treatment of OCD, the dominant behavioral technique in Classical Cognitive Behavioral Therapy (CBT), in which the first and second generations are expressed together, is Exposure and Response Prevention (ERP), and cognitive restructuring studies related to cognitive distortions, exaggerated responsibility, Thought Action Fusion (TAF) for cognitive interventions are discussed. Acceptance and Commitment Therapy (ACT), based on Relational Frame Theory, utilizes six psychological processes on a contextual basis. These are acceptance, cognitive dissociation, contextual self, contact with the present moment, values, and committed actions. ACT offers a new philosophical and humanistic approach to treatment by addressing problematic behaviors at the clinical level not only with their formal aspects but also with their functional aspects. Therefore, it includes individualized practices. In ACT, the therapist is in the position of accompanying the individual, making him/her realize that he/she is at the helm of his/her life and inviting the individual to treatment, instead of being the instructor and guide in CBT.

Anahtar Kelimeler

Acceptance and Commitment Therapy, Behavioral Therapy, Cognitive Behavioral Therapy, Cognitive Therapy, Obessive Compulsive Disorder

Kaynakça

• Allen, K. J. D., Krompinger, J. W., Mathes, B. M., Crosby, J. M., & Elias, J. A. (2016). Thought control strategies in patients with seve- re obsessive–compulsive disorder: Treatment effects and suicide risk. Journal of Obsessive-Compulsive and Related Disorders, 8, 31–37. https://doi.org/10.1016/j.jocrd.2015.11.004.
• APA (2013) Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). Washington DC, American Psychiatric Association.
• Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive be- havioral therapy (CBT) versus acceptance and commitment therapy (KKT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80(5), 750–765. https://doi.org/10.1037/a0028310
• Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55(11), 1247–1263. https://doi.org/10.1037/0003-066X.55.11.1247
• Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
• Baymur, F. (1994). Genel psikoloji. İnkılap Kitabevi.
• Biglan, A., Hayes, S. C., & Pistorello, J. (2008). Acceptance and commitment: Implications for prevention science. Prevention Science: The Official Journal of the Society for Prevention Research, 9(3), 139–152. https://doi.org/10.1007/s11121-008- 0099-4
• Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28(6), 612–624. https://doi.org/10.1016/j. janxdis.2014.06.008
• Bystritsky, A., Liberman, R. P., Hwang, S., Wallace, C. J., Vapnik, T., Maindment, K., & Saxena, S. (2001). Social functioning and qu- ality of life comparisons between obsessive-compulsive and schizophrenic disorders. Depression and Anxiety, 14(4), 214–218. https://doi.org/10.1002/da.106914 Catapano, F., Sperandeo, R., Perris, F., Lanzaro, M., & Maj, M. (2001). Insight and resistance in patients with obsessive-compulsive disorder. Psychopathology, 34(2), 62–68. https://doi.org/10.1159/000049282
• Clark, D. A. (1999). Cognitive behavioral treatment of obsessive-compulsive disorders: A commentary. Cognitive and Behavioral Practice, 6(4), 408–415. https://doi.org/10.1016/s1077-7229(99)80059-5
• Cullen, C. (2008). Acceptance and commitment Therapy (KKT): A third wave behaviour Therapy. Behavioural and Cognitive Psychotherapy, 36(6), 667–673. https://doi.org/10.1017/s1352465808004797
• Çiftçi, Ş., & Kuru, T. (2013). Obsesif Kompulsif Bozuklukta Düşünce Eylem Kaynaşması. Bilişsel Davranışçı Psikoterapi Ve Araştırmalar Dergisi, 2, 138-146.
• Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification, 37(3), 409–430. https://doi.org/10.1177/0145445512475134
• Didonna, F., Lanfredi, M., Xodo, E., Ferrari, C., Rossi, R., & Pedrini, L. (2019). Mindfulness-based cognitive therapy for obsessive-compulsive disorder: A pilot study.Journal of Psychiatric Practice,25(2), 156–170. https://doi.org/10.1097/ pra.0000000000000377
• Fisher, P. L., & Wells, A. (2005). How effective are cognitive and behavioral treatments for obsessive–compulsive disorder? A cli- nical significance analysis. Behaviour Research and Therapy, 43(12), 1543–1558. https://doi.org/10.1016/j.brat.2004.11.007
• Fletcher, L., & Hayes, S. C. (2005). Relational frame theory, acceptance and commitment therapy, and a functional analytic definition of mindfulness. Journal of Rational-Emotive and Cognitive-Behavior Therapy: RET, 23(4), 315–336. https://doi. org/10.1007/s10942-005-0017-7
• Freeston, M. H., & Ladouceur, R. (1997). What do patients do with their obsessive thoughts? Behaviour Research and The- rapy, 35(4), 335–348. https://doi.org/10.1016/s0005-7967(96)00094-0
• Gregg, J. A., Callaghan, G. M., Hayes, S. C. ve Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336-343.
• Gururaj, G. P., Math, S. B., Reddy, J. Y., & Chandrashekar, C. R. (2008). Family burden, quality of life and disability in obsessive compulsive disorder: an Indian perspective. Journal of postgraduate medicine, 54(2), 91–97. https://doi.org/10.4103/0022- 3859.407
• Gülnur Ş.H.; Bipolar bozukluk, obsesif kompulsif bozukluk, bipolar bozukluk ve obsesif kompulsif bozukluk eştanılı hastalar: klinik özellikler, kişilik ve mizaç özelliklerinin karşılaştırılması, Adnan Menderes Üniversitesi, Tıpta Uzmanlık Tezi, 2-60, (2016).
• Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 2-8.
• Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665. https://doi.org/10.1016/s0005-7894(04)80013-3.
• Hayes, S. C., Strosahl, K. D., Bunting, K., Twohig, M. ve Wilson, K. G. (2004). What is acceptance and commitment therapy?. In a practical guide to acceptance and commitment therapy (pp. 3- 29). Springer, Boston, MA.
• Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6). https:// doi.org/10.1037//0022-006x.64.6.1152
• Herbert, J. D., & Forman, E. M. (Eds.). (2011). Acceptance and mindfulness in cognitive behavior therapy: understanding and applying the new therapies. Hoboken: Wiley.
• Karaca, P., Oktay, S., Koçak, M., & Erden, G. (2020). Current psychotherapy approaches in treatment of obsessive compulsive disorder. Yeni Symposium, 0, 1. https://doi.org/10.5455/nys.20200418103657
• Leeuwerik, T., Cavanagh, K.8, & Strauss, C. (2019). Patient adherence to cognitive behavioural therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Anxiety Disorders, 68(102135), 102135. https://doi.org/10.1016/j. janxdis.2019.102135
• Lochner, C., & Stein, D. J. (2003). Heterogeneity of obsessive-compulsive disorder: a literature review. Harvard review of psychi- atry, 11(3), 113–132. https://doi.org/10.1080/10673220303949
• Manjula, M., & Sudhir, P. (2019). New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies. Indian Journal of Psychiatry, 61(7), 104. https://doi.org/10.4103/psychiatry.indianjpsychiatry_531_18
• Manjula, M., & Sudhir, P. (2019). New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies. Indian Journal of Psychiatry, 61(7), 104. https://doi.org/10.4103/psychiatry.indianjpsychiatry_531_18
• Marazziti, D., Dell’Osso, L., Di Nasso, E., Pfanner, C., Presta, S., Mungai, F., & Cassano, G. B. (2002). Insight in obsessive–compul- sive disorder: a study of an Italian sample. European Psychiatry: The Journal of the Association of European Psychiatrists, 17(7), 407–410. https://doi.org/10.1016/s0924-9338(02)00697-1
• Marks, I. M., Stern, R. S., Mawson, D., Cobb, J., & McDonald, R. (1980). Clomipramine and exposure for obsessive-compulsive rituals: 1. The British Journal of Psychiatry: The Journal of Mental Science, 136(1), 1–25. https://doi.org/10.1192/bjp.136.1.1
• Mataix-Cols, D., Rosario-Campos, M. C., & Leckman, J. F. (2005). A multidimensional model of obsessive-compulsive disor- der. The American journal of psychiatry, 162(2), 228–238. https://doi.org/10.1176/appi.ajp.162.2.22815
• Meyer V., Levy R. and Schnurer A. (1974) The behavioural treatment of obsessive compulsive disorders. Obsessional States (Edited by BEECH H. R.), Methuen, London.
• Mowrer, O. H. (1960). Learning theory and behavior. John Wiley & Sons Inc. Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive–compulsive disorder. Behaviour Research and Therapy, 35(7), 667–681. https://doi.org/10.1016/S0005-7967(97)00017-X
• Onaral, G. (2021). Obsesif-Kompulsif Bozuklukta Üçüncü Kuşak Terapilerin Etkililiği: Bir Gözden Geçirme. Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry, 13(2), 292–331. https://doi.org/10.18863/pgy.779029
• Otte, J., Schicktanz, N., & Bentz, D. (2023). Impact of the COVID-19 pandemic on obsessive-compulsive symptoms in the Swiss general population. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1071205
• Ögel, K. (2012). Bilişsel davranışçı terapilerde üçüncü dalga. Farkındalık (ayrımsama) ve kabullenme temelli terapiler. Ankara: HYB Basım Yayın.
• Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A sys- tematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. https://doi.or- g/10.1016/j.cpr.2015.06.003
• Özdel, K. (2015). Dünden bugüne bilişsel davranışçı terapiler: Teori ve uygulama. Turkiye Klinikleri J Psychiatry-Special Topi- cs, 8(2), 10-20.
• Patel, S. R., Carmody, J., & Simpson, H. B. (2007). Adapting mindfulness-based stress reduction for the treatment of obsessi- ve-compulsive disorder: A case report. Cognitive and Behavioral Practice, 14(4), 375–380. https://doi.org/10.1016/j.cbp- ra.2006.08.006
• Philip, J., & Cherian, V. (2021). Acceptance and commitment therapy in the treatment of Obsessive-Compulsive Disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders, 28(100603), 100603. https://doi.org/10.1016/j. jocrd.2020.100603
• Pilecki, B. C., & McKay, D. (2012). An experimental investigation of cognitive defusion. The Psychological Record, 62(1), 19–40. https://doi.org/10.1007/bf03395784
• Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-a- nalytic review. Psychotherapy and Psychosomatics, 78(2), 73–80. https://doi.org/10.1159/000190790
• Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-a- nalytic review. Psychotherapy and Psychosomatics, 78(2), 73–80. https://doi.org/10.1159/000190790
• Prochaska, J.O., & Norcross, J.C. (2014). Psikoterapi sistemleri: Teoriler ötesi bir çözümleme. İzmit: Psikoterapi Enstitüsü Yayınları. Purdon, C., & Clark, D. A. (1999). Metacognition and obsessions. Clinical Psychology & Psychotherapy, 6(2), 102–110. https://doi. org/10.1002/(sici)1099-0879(199905)6:2<102::aid-cpp191>3.0.co;2-5
• Rachman, S. (1998). A cognitive theory of obsessions: elaborations. Behaviour Research and Therapy, 36(4), 385–401. https:// doi.org/10.1016/s0005-7967(97)10041-9
• Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16(4), 233–248. https:// doi.org/10.1016/0005-7967(78)90022-0
• Rachman, S., Shafran, R., Mitchell, D., Trant, J., & Teachman, B. (1996). How to remain neutral: An experimental analysis of neut- ralization. Behaviour Research and Therapy, 34(11–12), 889–898. https://doi.org/10.1016/s0005-7967(96)00051-4
• Rohani,F.,Rasouli-Azad,M.,Twohig,M.P.,Ghoreishi,F.S.,Lee,E.B.,&Akbari,H.(2018).Preliminarytestofgroupacceptanceand commitment therapy on obsessive-compulsive disorder for patients on optimal dose of selective serotonin reuptake inhibitors. Journal of Obsessive-Compulsive and Related Disorders, 16, 8–13. https://doi.org/10.1016/j.jocrd.2017.10.002
• Rosaalcazar, A., Sanchezmeca, J., Gomezconesa, A., & Marinmartinez, F. (2008). Psychological treatment of obsessive–com- pulsive disorder: A meta-analysis☆. Clinical Psychology Review, 28(8), 1310–1325. https://doi.org/10.1016/j.cpr.2008.07.001
• Sakallı A.K; Obsesif kompulsif bozukluk tanısı alan hastaların afektif mizaç, kronobiyoloji ve dürtüsellik açısından incelenmesi, İstanbul Üniversitesi, Tıpta Uzmanlık Tezi, 1-26 (2014).
• Salkovskis P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour research and therapy, 37 Suppl 1, S29–S52.
• Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and The- rapy, 23(5), 571–583. https://doi.org/10.1016/0005-7967(85)90105-6
• Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Beha- viour Research and Therapy, 27(6), 677–682. https://doi.org/10.1016/0005-7967(89)90152-6
• Salkovskis, P. M. (1996). Cognitive-Behavioural Approaches to the Understanding of Obsessional Problems. In R. Rapee (Ed.), Current Controversies in the Anxiety Disorders. New York: Guilford.
• Salkovskis, P. M. (2003). Obsessions and compulsions. In Cognitive therapy in clinical practice (pp. 39-54). Routledge. Salkovskis, P. M., & Kirk, J. (1997). Obsessive-compulsive disorder. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy (pp. 179–208). Oxford University Press. Salzman,L.,&Thaler,F.H.(1981). Obsessive Compulsivedisorders:Areviewoftheliterature.TheAmericanJournalofPsychiatry, 138(3), 286–296. https://doi.org/10.1176/ajp.138.3.286
• Shafran, R., & Rachman, S. (2004). Thought-action fusion: a review. Journal of Behavior Therapy and Experimental Psychiatry, 35(2), 87–107. https://doi.org/10.1016/j.jbtep.2004.04.002
• Shafran, Roz, Thordarson, D. S., & Rachman, S. (1996). Thought-action fusion in obsessive compulsive disorder. Journal of Anxiety Disorders, 10(5), 379–391. https://doi.org/10.1016/0887-6185(96)00018-7
• Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386. https://doi.org/10.1002/jclp.20237
• Stanley, M. A., & Turner, S. M. (1995). Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behavior Therapy, 26(1), 163–186. https://doi.org/10.1016/s0005-7894(05)80089-9
• Steketee, G. S. (1993). Treatment of Obsessive Compulsive Disorder. New York: Guilford Press.
• Sungur MZ. OKB’nin Anlaşılması ve Tedavisinde Bilişsel Davranışçı Yaklaşımların Anksiyete Bozukluklarında Son Gelişmeler (Ed. N. Dilbaz). Ankara, Pozitif Matbaacılık, 2006.
• Sungur, M. Z. (2004). Obsesif kompulsif bozukluğun bilişsel davranışçı tedavisi. Tükel R. Editör. Anksiyete bozuklukları tedavi kılavuzu, 1, 171-189.
• Swedo SE, Snider LA (2004) The neurobiology and treaetment of obsessive-compulsive disorder. Neurobiology of Mental Ilness, DS Charney, EJ Nestler (Ed), Oxford University Press, Oxford, New York.
• Şafak Y, Karadere ME, Özdel K, Özcan T, Türkçapar MH, Kuru E et al. (2014) Obsesif kompülsif bozuklukta bilişsel davranışçı grup psikoterapisinin etkinliğinin değerlendirilmesi. Turk Psikiyatri Derg, 25:225-233.
• Thompson, B. L., Twohig, M. P., & Luoma, J. B. (2021). Psychological flexibility as shared process of change in acceptance and commitment therapy and exposure and response prevention for obsessive-compulsive disorder: A single case design study. Behavior Therapy, 52(2), 286–297. https://doi.org/10.1016/j.beth.2020.04.011
• Trent, E. S., Guzick, A. G., Viana, A. G., ve Storch, E. A. (2021). Third-wave cognitive behavioral therapy for obsessive compulsive disorder?: A promising approach if It includes exposure. Advances in Psychiatry and Behavioral Health, 1(1), 37-51.
• Twohig, M. P. (2009). The application of acceptance and commitment therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16(1), 18–28. https://doi.org/10.1016/j.cbpra.2008.02.008
• Twohig,M.P.,Hayes,S.C.,&Masuda,A(2006).Apreliminaryinvestigationofacceptanceandcommitmenttherapyasatreatment for chronic skin picking. Behaviour Research and Therapy, 44(10), 1513–1522. https://doi.org/10.1016/j.brat.2005.10.002
• Twohig, M. P., Plumb Vilardaga, J. C., Levin M. E., & Hayes, S. C. (2015). Changes in psychological flexibility during acceptance and commitment therapy for obsessive compulsive disorder. 4, 196-202.
• Twohig, M. P., Whittal, M. L., Cox, J. M., & Gunter, R. (2010). An initial investigation into the processes of change in KKT, CT, and ERP for OCD.International Journal of Behavioral Consultation and Therapy, 6(1), 67–83. https://doi.org/10.1037/h0100898
• Twohig, M.P., Abramowitz, J.S. ve Smith, B.M. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy. 108:1-9.
• Vakili, Y., Gharaee, B., & Habibi, M. (2015). Acceptance and commitment therapy, selective serotonin reuptake inhibitors and their combination in the improvement of obsessive-compulsive symptoms and experiential avoidance in patients with obsessi- ve-compulsive disorder. Iranian Journal of Psychiatry and Behavioral Sciences, 9(2). https://doi.org/10.17795/ijpbs845
• Weissman, M. M., Bland, R. C., Canino, G. J., Greenwald, S., Hwu, H. G., Lee, C. K., Newman, S. C., Oakley-Browne, M. A., Rubio-Sti- pec, M., & Wickramaratne, P. J. (1994). The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. The Journal of clinical psychiatry, 55 Suppl, 5–10.
• Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley & Sons Inc.
• Wheeler, C. H. B. (2017). Acceptance and commitment therapy-specific processes in the psychotherapeutic treatment of obsessive compulsive disorder: A single case study. Clinical Case Studies, 16(4), 313–327. https://doi.org/10.1177/1534650117694269 Wilson KG, Sandoz EK. Mindfulness, Values, and Therapeutic Relationship in Acceptance and Commitment Therapy. Hick SF, Bien T, ed. Mindfulness and the Therapeutic Relationship. New York: The Guilford Press; 2008:89–106.
• World Health Organization (2017). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva, Licence:CC BY-NC-SA 3.0 IGO.
• Yılmaz, B. (2018). Obsesif kompulsif bozukluk tedavisinde güncel yaklaşımlar. Lectio Scientific, 2(1) , 21-42. Retrieved from htt- ps://dergipark.org.tr/en/pub/lectiosc/issue/39038/457692
• Yu, L., Norton, S., & McCracken, L. M. (2017). Change in “self-as-context” (“perspective-taking”) occurs in acceptance and com- mitment therapy for people with chronic pain and is associated with improved functioning. The Journal of Pain: Official Jour- nal of the American Pain Society, 18(6), 664–672. https://doi.org/10.1016/j.jpain.2017.01.005