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Yıl:2013; Cilt: 6; Sayı: 3>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2013;6(3):60-68
Uykusuzluk Psikoterapisi: Bilişsel Davranışçı Yaklaşım
S Aslan
Gazi Üniversitesi, Ankara
Uykusuzluğun bilişsel-davranışçı tedavisinde olumsuz otomatik düşünceler, işlevi olmayan inançların uykusuzluk yakınmalarının sürmesindeki rolü hastayla birlikte ortaya çıkarılarak yerine daha az kaygı uyandırıcı düşünce ve inançlar oluşturulmaya çalışılır. Terapi programı ortalama 6-8 seanstan oluşmakta ve toplam 8 hafta sürmektedir. Uykusuzlukla ve sonuçlarıyla ilgili olumsuz düşünce ve varsayımlarının neler olduğunun farkındalığı artırılması ve alternatif inançların geliştirilmesi terapinin esas bileşenidir. Terapi sürecinde bilişsel müdahalelerin yanı sıra gevşeme egzersizleri, uyku ile yatağın ve yatak odasının özdeşleştirilmesi üzerinde çalışılır. İnsomniya birçok nedenden kaynaklanan bir sendrom olarak ele alındığı için tetikleyici ve sürdürücü etkenlerin saptanması önemlidir. Terapide uyku günlüğü tutulmalı, uyku hakkındaki olumsuz ve yardımı olmayan inançlarla mücadele edilmelidir. Uyku kısıtlama tedavisi uyku uyanıklık ritimini düzenleyerek uyku homeostazisinin yerleşmesine yardım eder. Tersine niyetlenme ile ''uykuya dalma kaygısı'' azaltılarak hastanın uyuma üzerine odaklanması engellenebilir, huzur verici imgeleri hayal ederek rahatlama ve böylece uykuya dalma, kas gevşetme egzersizleri uygulanabilir.
Psychotherapy of Insomnia: A Cognitive Behavioral Approach
In cognitive behavioral psychotherapy of insomnia, therapist cooperating with the patient, works on the worry, negative automatic thoughts about sleep and dysfunctional beliefs related sleep as trying to find alternative functional thoughts related sleep. Treatment program contains 6-8 session and lasts in 8 weeks. In treatment period, therapist tries to increase the patients' awareness about their negative thoughts and assumptions related consequences of insomnia, the main element of cognitive therapy. Beside the relaxation exercises, the positive condition of sleep and sleeping environment must be created. As insomnia can result in multiple causes, therapists try to find underlying precipitating and perpetuating factors. Keeping sleep diary, challenging to negative automatic thoughts and assumptions related to sleep has great importance. Sleep restriction is an important behavioral technique that reestablishes sleep wake rhythms and homeostasis of sleep. Progressive relaxation, paradoxal intention and positive imagination can also be added to psychotherapy processes.

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