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Yıl:2008; Cilt: 46; Sayı: 3>> Özet
TAM METİN
Yeni Symposium; 2008;46(3):143-153
Psikokütanöz Hastalıklarda Psikoterapötik Destek: Bilişsel Davranışçı Teknikler
A Hasanoğlu, A İşçimen
Basel Tıp Fakültesi Psikiyatri Anabilim Dalı, İsviçre
Dermatolojik hastalıklar üzerine yapılan birçok çalışma deri hastalıklarıyla ilişkili psikososyal etkenlere
dikkat çekmiştir. Bu etkenler arasında depresif duygudurum, bozulmuş beden imajı, azalmış özgüven, cinsel hayatın ve ilişkilerin bozulmasıyla hayat kalitesindeki genel bir kötüleşme sayılabilir. Zedelenebilirlik-stres modeli fiziksel hastalıkların oluşumunda ruhsal etkenlerin rolü hakkında en çok kabul gören açıklama modelidir. Bu modele göre, genetik bir yatkınlık varsa, diğerleriyle
birlikte emosyonel etkenler fiziksel hastalığın ortaya çıkmasına ve gidişine etki eder. Genelde
yaşamsal tehdit içermemesine rağmen dermatolojik hastalıklar, diğer organik bozukluklar
kadar sık uyum bozukluklarına neden olurlar. Son yıllarda, özellilkle atopik dermatit ve psoriasis
vulgaris gibi süregen deri hastalıklarına özgü terapi programları geliştirilmiştir. Dematolojik tedaviyle
bilişsel davranışçı tekniklerin kombine edildiği bu entegratif tedavi programları hastanın
hastalığı ve sonuçlarıyla başa çıkma becerileri edinmesini ve hastalık üzerindeki kontrol duygusunun
gelişmesini sağlamaktadır. Bu programlarda dermatolojik psikoedükasyon, sosyal beceri eğitimi,
kaşıntı/kaşıma döngüsünün kırılmasına yönelik davranışsal stratejiler, gevşeme teknikleri ve
gözlem protokolleri yer almaktadır. Tedavinin başarısı kendini deri belirtilerinin düzelmesi, hastanın anksiyetesinin azalması, depresif duygudurumun düzelmesi ve hayat kalitesinin artmasıyla
belli eder.
Psychotherapeutic Support by Psychocutaneous Diseases: Cognitive Behavioral Techniques
Research into the onset and manifestations of psychocutaneous diseases had drawn attention to
the psychosocial effects associated with skin diseases. These include depression, an impaired sense
of body image, decreased self-esteem, sexual and relationship difficulties and a general reduction
in quality of life. Vulnerability-stress model is the most recognized model to explain the
role of the psychological factors in the onset of diseases. According to this model, with the existence
of a genetic disposition, the emotional burden and other factors influence the onset or course
of the physical disease. Although they are not generally life-threatening, dermatological diseases
lead to adjustment disorders so frequently as other organic disorders. In the last [year]s,
special programs have been developed for chronic skin diseases like atopic dermatitis and psoriasis
vulgaris. Integrative therapy programs in which dermatological treatment and cognitive-behavioral
techniques are combined, can be considered an effective method in patients with a
psychocutaneous disease to increase their self-control by optimizing the skills in dealing with the
consequences of the skin disease. Such programs include dermatological psychoeducation, social
skill training, behavioral strategies to break the vicious circle of itching/scratching, relaxing
tecniques and observation protocols. The success of the treatment shows itself with improvement
of the skin symptoms, reduction in the anxiety and deppressive symptoms and increased
quality of life.

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