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Yıl:2017; Cilt: 2; Sayı: 3>> Özet
Türkiye Klinikleri Psikoloji Özel Dergisi; 2017;2(3):205-217
Travma Odaklı Terapilerin Teorik Temelleri, Klinik Uygulamaları ve Bilimsel Destekleri
E Şalcıoğlu
DABATEM Davranış Bilimleri Araştırma ve Tedavi Merkezi, İstanbul
Klinik tedavi araştırmalarını özetleyen meta-analizler travma sonrası stres hastalığında en etkili tedavilerin travma odaklı psikoterapiler olduğunu göstermektedir. Bunlar travmatik olayın kişi üzerinde yarattığı etkileri onun travmayla ilişkili düşünce, duygu ve davranışlarını değiştirerek ortadan kaldırmayı hedefleyen bilişsel ve davranışçı terapiler (BDT) ile göz hareketleriyle duyarsızlaştırma ve yeniden işlemedir (EMDR). Bu yazıda bu terapilerin teorik altyapıları, klinik uygulamaları, iyileşme sağlamada ne kadar etkili oldukları, danışanlar tarafından ne kadar kabul edildikleri ve klinik ortamlarda uygulanabilirlikleri değerlendirilmiştir. Ayrıca, BDT protokollerinde kullanılan her bir tedavi yönteminin iyileşmeye katkısını belirleyebilmek için yapılan bir meta-analizin bulguları verilmiştir. Terapi protokolleri travmayla ilişkili çevresel uyaranların yerinde üstüne gitme yöntemini barındırdığı zaman tedavi etkisinin arttığı, bu etkinin kısa sürede ortaya çıktığı ve takip dönemlerinde artarak kalıcılaştığı görülmektedir. Araştırmalar tedavide odağın korku ve diğer olumsuz duyguların azalmasındansa bu duygular ve bunları tetikleyen stresörler üzerinde kontrol duygusu sağlamaya kaymasının özellikle süregiden stresörlerin var olduğu afet ve savaş ortamlarında tedavi etkisini arttıracağını göstermektedir.
Theoretical Foundations, Clinical Applications and Evidence Base of Trauma-Focused Psychotherapies
Meta-analyses based on randomized controlled trials concluded that trauma-focused psychotherapies are most effective treatments for posttraumatic stress disorder. These include cognitive and behavioral therapies (CBT) and eye movement desensitization and reprocessing (EMDR). This article reviews these treatments in terms of their theoretical background, clinical application, efficacy, tolerability, and applicability in clinical settings. Furthermore, it presents the findings of a meta-analysis which examined the efficacy of CBT protocols with respect to their main therapeutic interventions. The findings show that trauma-focused treatments that include live exposure to environmental trauma reminders and cues achieve the highest levels of improvement in a short period of time and maintain and increase their effects in post-treatment follow-up phase. Studies Show that moving away from a focus on reduction of fear and other negative emotions during live exposure to development of sense of control over them will enhance treatment effects in post-disaster settings characterized by ongoing stressors.

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