Obsesif-Kompulsif Bozuklukta Üçüncü Kuşak Terapilerin Etkililiği: Bir Gözden Geçirme

Öz

Tekrarlayan obsesyonlar ve/veya kompulsiyonlar ile karakterize olan Obsesif-Kompulsif Bozukluk tedavisinde ilaç tedavisi ve Bilişsel Davranışçı Terapi olmak üzere 2 ana tedavi yaklaşımının etkililiği kanıtlanmış görünmektedir. Ancak tedaviyi yarıda bırakma oranlarının yüksek olması ve BDT sonrası kalıntı belirtilerin görülmesi, araştırmacıları farklı tedavi yaklaşımlarına yöneltmiştir. Bu bağlamda ortaya çıkan yeni gelişmeler, 3. Kuşak Terapiler açısından umut vermektedir. Bu gözden geçirme çalışmasında; Obsesif-Kompulsif Bozukluk’un tedavisinde kullanılan 3. Kuşak Terapilerin kuramsal alt yapısının özetlenmesi, bu bağlamdaki terapi yaklaşımlarının etkililiğine dair araştırmaların yöntemsel ve terapi süreci açısından gözden geçirilmesi amaçlanmıştır. Bu amaçla bu gözden geçirme çalışmasında; 2004-2020 yılları arasında İngilizce/Türkçe dilinde yayınlanmış ve Ebscohost, Ulakbim, Google Akademik, Science Direct ve Web of Science olmak üzere 5 veri tabanından ulaşılan Kabul ve Kararlılık Terapisi, Bilinçli Farkındalık Temelli Terapi, Üstbilişsel Terapi, Şema Terapi ve Diyalektik Davranış Terapisi’nin obsesif-kompulsif bozukluk’taki etkililiğini inceleyen araştırmalara yer verilmiştir. Yapılan gözden geçirme sonucunda, 3. Kuşak Terapiler’in genel olarak obsesif kompulsif belirtileri azalttığı görülmüştür. Buna ek olarak, depresyon, anksiyete ve stres belirtilerinde azalma; öz-şefkat ve bilinçli farkındalık gibi becerilerde ise artış sağladığı belirlenmiştir. Buradan yola çıkarak, Obsesif-Kompulsif Bozukluk tedavisinde 3. Kuşak Terapiler’in yetişkin örneklemindeki etkililiğine dair ilk kanıtların birikmeye başladığı ancak daha büyük örneklemler ile bilişsel davranışçı terapi, maruz bırakma ve tepki önleme ya da ilaç tedavisi ile karşılaştırmalı olarak yapılan seçkisiz kontrollü klinik çalışmalara ihtiyaç olduğu sonucuna ulaşılmıştır.

Anahtar Kelimeler

• Obsesif Kompulsif Bozukluk, Kabul ve Kararlılık Terapisi
• Bilinçli Farkındalık Temelli Terapi
• Üstbilişsel Terapi
• Tehlike Düşüncesini Azaltma Terapisi
• Bilişsel Başa Çıkma Terapisi

Effectiveness of Third Wave Therapies for Treatment of Obsessive-Compulsive Disorder: A Review

Öz

In the treatment of obsessive-compulsive disorder, the effectiveness of two main treatment approaches, pharmacotherapy and cognitive behavioral therapy (CBT), has been proven. However, the high rates of drop out from treatment and the presence of residual symptoms after CBT direct researchers to look for different treatment approaches. Therefore, emerging developments show that Third Wave Therapies are promising. In this review; it is aimed to summarize the theoretical background of Third Wave Therapies used in the treatment of obsessive-compulsive disorder and to review the effectiveness of these approaches and examine these studies in terms of methodological perspective and therapy content. In accordance with this purpose, studies which examine the effectiveness of Acceptance and Commitment Therapy, Mindfullness-Based Therapy, Metacognitive Therapy, Schema Therapy and Dialectical Behavior Therapy which are published in English/Turkish between 2004-2020 years and accessed from 5 databases: Ebscohost, Ulakbim, Google Scholar, Science Direct and Web of Science are included. As a result of this review, it has been determined that Third Wave Therapies generally reduce obsessive-compulsive symptoms and result in both reductions on depression, anxiety and stress symptoms and improvements on skills such as self-compassion and mindfulness. Based on these results, it was concluded that the first evidences about the effectiveness of Third Wave Therapies in the adult population in the treatment of obsessive-compulsive disorder begin to accumulate, but there is a need for randomize clinical controlled trials which is performed with larger samples and compared with cognitive behavioral therapy, exposure and response prevention or pharmacotherapy.

Anahtar Kelimeler

• Obsessive-compulsive disorder
• acceptance and commitment therapy
• mindfulness
• meta-cognition
• waves

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