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Um hugræna atferlismeðferð og athafnasemismeðferð við þunglyndi

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Authors
Ívar Snorrason
Haukur Ingi Guðnason
Issue Date
2008

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Other Titles
Cognitive behavioural therapy and behavioural activation for depression
Citation
Sálfræðiritið 2008, 13:199-211
Abstract
Fjöldi rannsókna hefur sýnt að hugræn atferlismeðferð (HAM) er áhrifarík leið til að draga úr þunglyndi og koma í veg fyrir hrösun. Aftur á móti er lítið vitað um það hvers vegna meðferðin virkar. Samkvæmt hugrænni kenningu Becks dregur meðferðin úr þunglyndi vegna þess að hún breytir kjamaviðhorfum sem kenningin gerir ráð fyrir að liggi að baki þunglyndi. Meðferðin er hins vegar margþætt og margar mögulegar skýringar á árangri hennar. í greininni verður farið yfir rannsóknir sem gefa til kynna að atferlisþáttur meðferðarinnar sé einkar mikilvægur. Fjallað verður í stuttu máli um rannsóknir á árangri HAM og í framhaldinu sagt ítarlega frá tveimur viðamiklum rannsóknum sem benda til þess að athafnasemismeðferð (AM), sem er fyrsti hluti HAM, beri a.m.k. jafn mikinn árangur og HAM í heild sinni. Einnig verða teknar saman rannsóknir á eiginleikum sjúklinga sem geta gefið vísbendingu um það hvort þeir svari betur AM eða HAM. í lokin verður fjallað um það hvað þessar niðurstöður þýða fyrir meðferð við þunglyndi hér á landi.
A number of clinical trials have shown that cognitive behavioral therapy (CBT) is effective in reducing depressive symptoms and preventing relapse among depressed patients. However little is known about why the therapy works. According to Beck et al. (1979) the active change mechanism in CBT are interventions that focus on cognitive structures or core schema. However, CBT is a multi component therapy and other factors might explain its success. The current article reviews the efficacy literature in CBT with a special focus on two large scale component analyses that indicate that behavior activation (BA), which is the first part of traditional CBT, is at least as effective as the full CBT package. Also, research on patient characteristics in relation to treatment response in CBT versus BA will be reviewed. The implications of these findings for treatment of depression in Iceland are discussed.
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