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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

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