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Yıl:2013; Cilt: 3; Sayı: 1>> Özet
Psikiyatride Güncel; 2013;3(1):84-94
Somatoform bozukluklarda bilișsel davranıșçı terapi
Y Șafak, MH Türkçapar
Dıșkapı Yıldırım Beyazıt Eğitim ve Araștırma Hastanesi , Ankara
Somatoform bozukluklar, yeterli bir tıbbi açıklamanın bulunamadığı fiziksel belirtileri (örneğin; ağrı, bulantı ve baş dönmesi) içeren bir grup bozukluktur. Somatik (bedensel) belirti ve yakınmalar hastada belirgin duygusal sıkıntıya ya da toplumsal ve mesleki rollerde işlev bozukluğuna yol açacak derecede ciddidir. Somatoform bozukluklarda fiziksel ve psikolojik belirtiler arasındaki ilişki açıkça kurulmuş olmasına rağmen, bu ilişkinin mekanizmaları henüz açıklanamamıştır. Somatoform bozuklukların tedavisinde bilişsel davranışçı terapinin kullanılması 80’li yıllarda başlamış, günümüze doğru geldikçe de her bir somatoform bozukluğa özgü ayrı tedavi protokolleri geliştirilmiştir. Genel olarak somatoform bozukluk düşünülen tüm hastalarda ilk dikkat edilmesi gereken şey bu hastaların psikolojik değerlendirme ve tedaviye olan tepkilerini öğrenmek ve buna uygun biçimde terapötik işbirliğini sağlamaktır. Somatizasyon sendromunun tipine göre yapılacaklar değişmekteyse de bu grup rahatsızlıkların bilişsel davranışçı terapisi, psikoeğitim, sorun çözme eğitimi, iletişim becerileri ve atılganlık eğitimi, davranışsal aktivasyon, bilişsel yeniden yapılandırma ve gevşemeyi içerir. Genel olarak, psikososyal müdahaleler somatizasyon spektrum bozuklukları ile ilişkili fiziksel belirtileri azaltmada orta derecede etkili olmuştur. Bu hastaların bedensel sorunları için tek bir doktora devam etmeleri tedavinin önemli amaçlarından biridir. Bilişsel olarak bu rahatsızlığa özgül olarak yapılması hedeflenen şey hastanın belirtilerinin gerçek olduğunun onaylanması ancak bu belirtileri için kendi yaptığı açıklamaların gerçekçi olmadığı ve işlevsel sonuçlara yol açmadığı aksine davranış değişikliği ve kaçınma yoluyla belirtilerin daha da yoğunlaşmasına yol açtığını göstermektir. Bilişsel davranışçı tedavinin bu rahatsızlık grubunda etkili olduğuna ilişkin veriler giderek artmakta olup bu gelişmenin tedavisinde zorlanılan bu grup hastalarda tedavi açısından yeni imkan sağladığı görülmektedir.
Cognitive behavioral therapy in somatoform disorders
Somatoform disorders are characterized by physical symptoms (such as pain, nausea and dizziness) that suggest medical condition but are not fully explained by a medical condition. Somatic signs and symptoms cause the patient significant emotional distress or deterioration in social and occupational functioning. Although the association between physical and psychological symptoms has been clearly established, the mechanism explaining this association has yet to be identified. The use of cognitive-behavioral therapy in the treatment of somatoform disorders began in the 80s through to the present day in the different treatment protocols have been developed for each specific somatoform disorder. In general, the first thing that should be considered in patients with somatoform disorder is to learn their response to psychological assessment and treatment and accordingly to ensure that the therapeutic alliance. Various psychosocial interventions have been used to treat various types of somatization syndromes.The treatment of these diseases with cognitive behavioral therapy, provides problem-solving training, communication skills-assertiveness training, behavioral activation, cognitive restructuring and relaxation. In general, psychosocial interventions have been moderately effective in reducing the physical symptoms associated with somatization spectrum disorders. One of the important objectives of treatment, patients should continue only one physician. Targeted specifically to cognitive symptoms of this disorder to approve that symptoms of patients are real but his or her explanations for these symptoms is not realistic. The data on the effectiveness of cognitive behavioral therapy on this group is increasing. Cognitive-behavioral therapy (CBT) aims to alter dysfunctional thoughts and behaviors associated with somatization symptoms. This development provides new possibilities for the treatment of this group of patients that have difficulties in treatment.

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