Obsesif-Kompulsif Bozuklukta Metakognitif Mekanizmalar: Düşünce Kaynaşması, Ritüel İnançları ve Durdurma Sinyalleri

Öz

Obsesif kompulsif bozukluğu açıklamaya yönelik bilişsel modeller, belirtilerin sürdürülmesini büyük ölçüde düşüncelerin içeriğine yüklenen işlevsiz inançlarla ilişkilendirmektedir. Metakognitif yaklaşım ise obsesif kompulsif bozukluğu düşüncenin içeriğinden çok, bireyin düşünceleriyle kurduğu ilişki, bu düşüncelere yüklediği anlam ve davranışlarını düzenleme biçimi üzerinden ele almaktadır. Bu derlemede, obsesif kompulsif bozuklukta öne çıkan üç temel metakognitif mekanizma olan düşünce kaynaşması, ritüel inançları ve durdurma sinyalleri kuramsal çerçeve ve ampirik bulgular ışığında bütüncül biçimde değerlendirilmiştir. Ayrıca bu mekanizmaların obsesyonların tehdit olarak yorumlanması, kompulsiyonların başlatılması ve davranışların sonlandırılamaması süreçleriyle ilişkisi birlikte ele alınmıştır. Bulgular, düşünce kaynaşmasının obsesyonların tehdit edici biçimde yorumlanmasını destekleyebileceğini, ritüel inançlarının kompulsif davranışları gerekli, koruyucu ve sorumlulukla ilişkili eylemler olarak meşrulaştırabileceğini, durdurma sinyallerindeki bozulmanın ise davranışların tamamlanma ve sonlandırılma sürecini güçleştirebileceğini düşündürmektedir. Bu üç mekanizmanın karşılıklı etkileşimi, obsesif kompulsif belirtilerin döngüsel biçimde sürdürülmesine ilişkin bütüncül bir metakognitif modelle uyumlu görünmektedir. Sonuç olarak, metakognitif süreçlerin birlikte değerlendirilmesi obsesif kompulsif bozukluğun sürdürülme mekanizmalarının daha iyi anlaşılmasına, klinik müdahalelerin daha hedefe yönelik yapılandırılmasına ve gelecekteki araştırmalar için daha kapsamlı modeller geliştirilmesine katkı sağlayabilir.

Anahtar Kelimeler

• obsesif kompulsif bozukluk
• metakognisyon
• düşünce kaynaşması
• ritüel inançları
• durdurma sinyalleri

Metacognitive Mechanisms in Obsessive Compulsive Disorder: Thought Fusion, Ritual Beliefs, and Stop Signals

Öz

Cognitive models of obsessive compulsive disorder largely relate the maintenance of symptoms to dysfunctional beliefs attributed to the content of thoughts. The metacognitive approach, in contrast, conceptualizes obsessive compulsive disorder not primarily through the content of thoughts, but through the individual’s relationship with thoughts, the meanings assigned to them, and the way behaviors are regulated. In this review, three central metacognitive mechanisms in obsessive compulsive disorder—thought fusion, ritual beliefs, and stop signals—are evaluated integratively in light of theoretical accounts and empirical findings. In addition, the associations of these mechanisms with the interpretation of obsessions as threats, the initiation of compulsions, and the difficulty in terminating behaviors are considered together. Findings suggest that thought fusion may contribute to the threatening interpretation of obsessions, ritual beliefs may legitimize compulsive behaviors as necessary, protective, and responsibility-related actions, and impairments in stop signals may make the completion and termination of behaviors more difficult. The reciprocal interaction of these three mechanisms points to an integrative metacognitive model for the cyclical maintenance of obsessive compulsive symptoms. In conclusion, evaluating metacognitive processes together may contribute to a better understanding of the maintenance mechanisms of obsessive compulsive disorder, to more targeted clinical interventions, and to the development of more comprehensive models for future research.

Anahtar Kelimeler

• obsessive compulsive disorder
• metecognition
• thought fusion
• ritual beliefs
• stop signals

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