Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Yeme Bozukluklarında Geliştirilmiş Bilişsel Davranışçı Terapi-Temel Bilgiler: Geleneksel Derleme
Enhanced Cognitive Behavioral Therapy for Eating Disorders-Basics: Traditional Review
Emel SARIa
aSerbest Hekim, İstanbul, Türkiye
Turkiye Klinikleri J Health Sci. 2023;8(1):145-52
doi: 10.5336/healthsci.2022-92921
Article Language: TR
Full Text
ÖZET
 Yeme bozukluklarının altında yatan temel mekanizma, bilişsel aşırı değerlendirme sürecine bağlı olduğu için 'bilişsel davranışçı terapi'nin uygun bir tedavi yöntemi olduğu düşünülmüş ve 'geliştirilmiş bilişsel davranışçı terapi' ortaya çıkmıştır. Yeme bozukluklarının hemen hepsinin temelinde yatan psikopatoloji kilo, vücut şekli ve bunları kontrol etmeyi aşırı değerlendirme üzerine kuruludur. Bu patoloji, olguların yeme alışkanlıklarında katı kurallar edinmelerine, yemeyi kısıtlamalarına, aşırı egzersiz yapmalarına ve telafi edici davranışlar geliştirmelerine neden olur. Olguların bir kısmında, gün içinde yemeyi kısıtlama sonrasında aşırı yeme atakları meydana gelir ve bu atakları takip eden kusma, laksatif ve diüretik yanlış kullanımı ya da aşırı egzersiz yapma gibi telafi davranışları görülür. Geliştirilmiş bilişsel davranışçı terapi, etkinliği bilimsel araştırmalarla kanıtlanmış, gençler ve erişkinlerde ayaktan ya da yatarak tedavide uygulanabilen, yapılandırılmış bir terapi yöntemidir. Dört aşamadan oluşur. Birinci aşama yoğun bir başlangıç sürecidir ve seanslar haftada 2 kez gerçekleştirilir. Birinci aşamanın hedefleri hastayı tedavi sürecine ve değişime angaje etmek, beraber kişisel bir formülasyon oluşturmak, gerekli eğitimi sağlamak ve 2 güçlü geliştirilmiş bilişsel davranışçı terapi sürecini sunmaktır. Bunlar 'seans içinde tartılma' ve 'düzenli yeme'dir. İkinci aşamada o zamana kadar geçirilen süreç gözden geçirilir, değişimi engelleyen bariyerler belirlenir. Üçüncü aşama tedavinin ana gövdesini oluşturur. Amaç yeme bozukluğunu sürdüren ana mekanizmaları ele almaktır. Dördüncü aşama tedavinin son aşamasıdır ve 2 hedef vardır. İlki değişimin korunmasından emin olmak, diğeri ise uzun vadede tekrar etme riskini en aza indirmektir. Bu geleneksel derlemede, geliştirilmiş bilişsel davranışçı terapinin yeme bozukluklarında uygulanması ile ilgili temel bilgiler verilecektir.

Anahtar Kelimeler: Aşırı yeme bozukluğu; anoreksia; bulimia; adölesan; beslenme ve yeme bozuklukları
ABSTRACT
 Since the underlying mechanism of eating disorders is dependent on the cognitive over-evaluation process, 'cognitive behavioral therapy' was thought to be an appropriate treatment method and 'enhanced cognitive behavioral therapy' emerged. The psychopathology underlying almost all eating disorders is based on overestimating weight, body shape and controlling them. This pathology causes the cases to adopt strict rules in their eating habits, to restrict eating, to exercise excessively, and to develop compensatory behaviors. In some of the cases, binge eating attacks occur after restricting eating during the day, followed by compensatory behaviors such as vomiting, misuse of laxatives and diuretics, or excessive exercise. Enhanced cognitive behavioral therapy is a structured therapy method whose effectiveness has been proven by scientific research and can be applied in outpatient or inpatient treatment for young people and adults. It consists of 4 stages. The first phase is an intensive initial phase and sessions are held twice a week. The goals of the first phase are to engage the patient in the treatment process and change, together create a personal formulation, provide the necessary training, and present two powerful enhanced cognitive behavioral therapy processes. These are 'weighing in session' and 'regular eating'. In the second stage, the process until then is reviewed, and the barriers that prevent change are determined. The third stage constitutes the main body of the treatment. The aim is to address the main mechanisms that perpetuate the eating disorder. The fourth stage is the final stage of treatment and has 2 goals. The first is to ensure that change is maintained, and the other is to minimize the risk of recurrence in the long run. In this traditional review, basic information about the application of enhanced cognitive behavioral therapy in eating disorders will be given.

Keywords: Binge-eating disorder; anorexia; bulimia; adolescent; feeding and eating disorder
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