Dergi Ara >>
Yıl:2003; Cilt: 16; Sayı: 2>> Özet
TAM METİN
Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2003;16(2):87-94
Varsanılarla ilgili İnançlar Ölçeği: Güvenilirlik ve geçerlik çalışması
T Aker, A Yazıcı, N Üstün, A Alpaslan, İ Yılmaz, E Beştepe, H Akar
Chadwick ve Birchwood tarafından Ellis'in ABC modeline dayanan işitsel varsanılar için kognitif bir formülasyon modeli önerilmiştir. Bu modele göre; seslere verilen tepkiler (Sonuç Consequances/C) seslerin kimliği, gücü, amacı, onlara itaat edip etmemenin sonuçları gibi sesler hakkındaki bazı inançlar (beliefs/B) tarafından belirlenir. Bu kavramların geçerlilik ve güvenirliğini sağlamak amacıyla 30 itemlik Varsanılarla İlgili İnançlar Ölçeği (VİÖ) geliştirilmiştir. Bu çalışma, Türk kültüründe, seslerle ilgili olarak bahsedilen kavramların geçerlik ve güvenilirliğini araştırmayı amaçlamaktadır. Çalışma, şizofreni hastalarındaki hezeyanlar, varsanılar, inançlar, işlevsel olmayan varsayımlar, atıflar ve diğer ilişkili durumların bilişsel-davranışçı modele göre formülasyonunu ve tedavisini açıklamayı amaçlayan bir araştırmanın bir bölümüdür. Çalışmaya Bakırköy Ruh ve Sinir Hastalıkları Hastanesi 1. ve 2. psikoz birimlerinden DSM-IV tanı kriterlerine göre Şizofreni-Paranoid Tip tanısı almış 35 hasta alınmıştır. Zihinsel yetersizlik ve okuma yazma bilmemek dışlama kriterleri olarak kabul edilmiştir. Hastaların tümü antipsikotik tedavi kullanmaktaydı. Bilgiler bir kendini bildirim (self-rating) ölçek olan Varsanılarla İlgili İnançlar Ölçeği (VİÖ) ile elde edilmiştir. Bu ölçek, seslere yönelik, iyi niyet, kötü niyet, direnme ve benimseme kavramlarını değerlendirmek için geliştirilmiştir. Ölçek Türkçe'ye uyarlanmıştır ve pilot görüşmeler yapılmıştır. Yarı yapılandırılmış bir görüşme de bu ölçekle birlikte uygulanmıştır. Bu görüşme, varsanıların içeriği, seslerin kimliği, gücü, amacı hakkındaki inançlar, seslere uymanın sonuçları, hastanın sesleri kontrol edebilmesi gibi bazı durumları değerlendirmeyi amaçlamıştır. Bu görüşmenin sonuçları çalışmanın geçerliğini değerlendirmek amacıyla kullanılmıştır. Tanımlayıcı ve ilişki analizleri ile bağımsız gruplar arasındaki farklılık testleri ve güvenilirlik analizleri uygulanmıştır. Sonuçlar, VİÖ'nün seslerin kognitif özelliklerini değerlendirmek için değerli bir ölçek olduğunu göstermiştir. Seslerin içeriği ve hastanın bununla ilişkili duyguları ve davranışları arasında bir ilişki bulunmuştur. Bu yüzden seslerin içeriği ile ilgili olarak pek çok hastada seslere direnç gösterme ve sesleri benimseme durumları öngörülebilmiştir. İyi niyet, kötü niyet, benimseme ve direnme kavramları hastalar tarafından oldukça iyi ayırdedilebilmiştir. Bu sonuçlar ölçeğin güvenilirliğini göstermiştir. VİÖ aynı zamanda işitsel varsanılara yönelik bilişsel terapi uygulamaları ile tedavi etkinliğini değerlendirmede yararlı bir araçtır.
A cognitive formulation of auditory hallucinations based on Ellis's ABC model was proposed by Chadwick and Birchwood. According to this model, reactions to voices (consequances/C) were mediated by beliefs (B) about the voices identity, power, purpose, consequance of obeidance and disobeidance, related symptoms and etc. In order to establish the reliability and validity of these concepts a thirty item Beliefs About Voices Questtionnaire (BAW-Q9 was developed. This study aimed to search the reliability and validity of these concepts in Turkish culture. The study is part of a research that aimed to clarify the cognitive-behavioural formulation and treatment of delusions, hallucinations, beliefs, dysfunctionnal assumptions, attributions and other related issues in schizophrenic patients. The 35 participants were selected consequently from Bakirköy Psychiatric and Neurological Diseases Hospital I. and II. Psychotic Disorders Units. All participants met DSM-IV diagnostic criteria for schizophrenia, paranoid type. Diminished mental capacity to perform an interview and illeteracy are accepted as exclusion criterias. All were receiving antipsychotic medication. Information was gathered by BAV-Q, a self rating scale. BAV-Q was developed to measure the concepts about malovalance, benoalance, resistance and engagement to voices. The scale was adapted into Turkish and pilot interviews were done. A semistructured interview was also performed consequently with BAV-Q. This includes hallucination's content, beliefs about the voices identity, power and purpose of the voice, the consequances of compliance, related symptoms, patient's control over the voices and the other related issues. The results of this interview was used as the validity purposes of the study. Descriptive, correlatinal and independent samples and reliability analysis were performed. As the results indicated, BAV-Q was a reliable and valid instrument in order to assess the cognitive properties of the voices. There was a relation between the voice content and the patient's associated feelings and behaviours. Therefore in many cases resistance and engagement might have been predicted on the basis of content. The concepts about malovalence, benovalence, engagement and resistance were discriminated well by the patients. These results showed the validity of the scale. BAV-Q has also a promising attempt to apply cognitive therapy to auditory hallucinations and might have usefull treatment implications.

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