Farkındalık temelli terapiler ve terapötik süreçler

Farkındalık (mindfulness), dikkatin şimdiki ana yöneltilerek, anlık deneyimlerin yargılanmadan ve kabullenmeyle gözlemlenmesine dayanmaktadır. Farkındalık, otuz yıla yakın bir süredir Batı'daki psikoterapi yaklaşımları içerisinde bir terapi yöntemi olarak kullanılmaktadır. Kökenleri Doğu'nun kişisel gelişim pratiklerine dayanan farkındalığı, psikolojik süreçler temelinde açıklamaya çalışan pek çok çalışma olduğu görülmektedir. Farkındalıkla ilgili araştırmaların bir bölümü Farkındalık Temelli Terapilerin etki mekanizmalarına yöneliktir. Üst biliş, duygulanım düzenleme, dikkat düzenleme ve içsel maruz bırakma Farkındalık Temelli Terapilerin içerdiği değişim mekanizmaları olarak önerilmiştir. Farkındalığı üstbilişsel bir bilgi işlemleme süreci olarak ele alan görüşlerde, farkındalığın içerdiği bilişsel uzaklaşma yoluyla, işlevsiz üst biliş inanışlarının etkisinin azaldığı belirtilmektedir. Farkındalığın duygulanım düzenleme üzerindeki olumlu etkileri Farkındalık Temelli Terapi uygulamalarına önemli bir etki mekanizması olarak ortaya çıkmaktadır. Farkındalığın duygulanımsal toleransı ve işlevsel duygulanım düzenlenmesini desteklediğini belirten görüşler bulunmaktadır. Şimdiki ana odaklanmış dikkatin, farkındalığın temel bileşenlerinden olduğu düşünülmektedir. Farkındalığın dikkat süreçleri üzerindeki etkilerini inceleyen çalışmalarda, farkındalık ile dikkat bileşenleri arasında ilişki bulunduğu görülmüştür. Olumlu veya olumsuz tüm içsel yaşantılara yönelimi içeren farkındalığın, içsel maruz bırakma yöntemiyle benzer etki mekanizmasına sahip olduğu düşünülmektedir. Farkındalığın bilişsel ve duygulanımsal süreçlerle ilişkisini açıklayan pek çok görüş ve bulgu ortaya konulduğu görülmektedir. Anılan bulgular farkındalığın operasyonel düzeyde tanımlanması ve Farkındalık Temelli Terapilerin etkililiğinin yükseltilmesi açısından önemli bir adımdır.

Mindfulness based therapies and therapeutic processes

Mindfulness is based on focusing attention to present moment and observing present moment experiences in a non-judgmental and accepting way. Mindfulness has been applied as a therapy method in Western psychotherapy practice for almost thirty years. While mindfulness stems from Eastern contemplative practices, a number of studies had investigated the psychological processes underlying mindfulness. Some of these studies focused on explaining the change mechanisms through which mindfulness-based interventions have their therapeutic effects. Meta-cognition, emotion regulation, attention regulation and interoceptive exposure have been suggested as change mechanisms involved in mindfulness based therapies. The notion explaining mindfulness as a meta-cognitive information processing asserts that the decentering involved in mindfulness decreases the effects of maladaptive meta-cognitive beliefs. The incremental effect of mindfulness on emotion regulation is another proposed effect mechanism in mindfulness-based interventions. This view suggests that mindfulness supports emotional tolerance and adaptive emotion regulation. The present-focused attention is regarded as a fundamental component of mindfulness. In studies investigating the effects of mindfulness on attentional processes, relationships have been found between mindfulness and the components of executive attention. It has also been proposed that interoceptive exposure technique and mindfulness operate through a similar therapeutic mechanism since mindfulness involves orientation towards all negative and positive subjective experiences. A number of views have been proposed regarding the relation between mindfulness and cognitive and emotional processes and the findings supported the effects of mindfulness on these processes. This is an important step towards explaining mindfulness on an operational level and increasing the effectiveness of mindfulness-based interventions.

Kaynakça

Anderson ND, Lau MA, Segal ZV ve ark. (2007) Mindfulnessbased stress reduction and attentional control. Clin Psychol Psychother, 14:449-463.

Arch JJ, Craske MG (2006) Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther, 44:1849-1858.

Baer RA (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract, 10:125-143.

Baer RA (2007) Mindfulness, assessment, and transdiagnostic processes. Psychol Inq, 18:238-271.

Barnard PJ, Teasdale JD (1991) Interacting cognitive subsystems: a systemic approach to cognitive-affective interaction and change. Cognition Emotion, 5:1-39.

Barnhofer T, Crane C, Hargus E ve ark. (2009) Mindfulnessbased cognitive therapy as a treatment for chronic depression: a preliminary study. Behav Res Ther, 47:366-373.

Bishop SR, Lau, M, Shapiro S ve ark. (2004) Mindfulness: a proposed operational definition. Clin Psychol Sci Pract, 11:230-241.

Bowen S, Witkiewitz K, Dillworth TM ve ark. (2007) The role of thought suppression in the relationship between mindfulness meditation and alcohol use. Addict Behav, 32:2324-2328.

Brown KW, Ryan RM (2003) The benefits of being present, mindfulness and its role in psychological well-being, J Pers Soc Psychol, 84: 822-848.

Brown KW, Cordon, S (2009) Toward a Phenomenology of Mindfulness: Subjective Experience and Emotional Correlates, Clinical Handbook of Mindfulness, 1. Baskı, F. Didonna (Editör), New York, Springer Publishing, s.59-81.

Carmody J, Baer RA, Lykins, ELB ve ark. (2009) An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. J Clin Psychol, 65:1-14.

Chambers R, Lo BCY, Allen NB (2009) The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Ther Res, 32: 303-322.

Coffey KA, Hartman M (2008) Mechanisms of action in the inverse relationship between mindfulness and psychological distress. Comp Health Prac Rev, 13:79-91.

Cooper ML, Frone MR, Russell M ve ark. (1995) Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol, 69: 990-1005.

Corcoran KM, Segal ZV (2008) Metacognition in depressive and anxiety disorders: current directions. Int J Cogn Ther, 1:33- 44.

Craske MG, Barlow DH, Meadows EA (2000) Mastery of your anxiety and panic: Therapist guide for anxiety, panic, and agoraphobia, San Antonio, Graywind Publishing/The Psychological Corporation.

Çatak PD, Ogel K (2010) Bir terapi yöntemi olarak farkındalık. Nöropsikiyatri Arþivi, 47:69-73.

Folette V, Palm KM, Pearson, AM (2006) Mindfulness and trauma: implications for treatment. J Rat-Emo Cognitive-Behav Ther, 24:45-61.

Garland E, Gaylord S Park J (2009) The role of mindfulness in positive reappraisal. Explore, 5:37-44.

Garland EL (2007) The meaning of mindfulness: a second order cybernetics of stres, metacognition and coping. Comp Health Prac Rev, 12:15-30.

Gross JJ (1998) Antecedent and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. J Pers Soc Psychol,74:224 -237.

Hayes AM, Feldman G (2004) Clarifying the construct of mindfulness in the context of emotion regulation. Clin Psychol Sci Pract, 11:255-262.

Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and Commitment Therapy: an Experiental Approach to Behaviour Change, New York, Guilford Press.

Hayes, SC (2004) Acceptance and commitment therapy, relational frame theory, and the third wave of behaviour therapy. Behav Ther, 35:639-65.

Hofmann SG, Asmundson GJ (2008) Acceptance and mindfulness- based therapy: new wave or old hat? Clin Psychol Rev, 28: 1-16.

Jain S, Shapiro SL, Swanick S ve ark. (2007) A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med, 33:11-21.

Jha AP, Krompinger J, Baime M (2007) Mindfulness training modifies subsystems of attention. Cogn Affect Behav Neurosci, 7:109-119.

Johnson C, Larson R (1982) Bulimia: An analysis of moods and behavior. Psychosom Med, 44: 341-351.

Kabat-Zinn J (1982) An outpatient program in behavioral medicine for chronic pain patients based on thepractice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry, 4:33-47.

Kabat-Zinn J (2003) Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pract, 10(2):144- 156.

Kabat-Zinn J (2005) Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, 3.baský, New York, Bantam Dell, s.34.

Kabat-Zinn J, Massion MD, Kristeller J ve ark. (1992) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry, 149:936- 943.

Kristeller JL, Baer RA, Quillian-Wolever R (2006). Mindfulness-based approaches to eating disorders, Mindfulness and Acceptance-Based Interventions: Conceptualization, Application, and Empirical Support. 1. Baský, R. Baer (Ed), San Diego CA, Elsevier, s.75-91.

Kuyken W, Byford S, Taylor RS ve ark.(2008) Mindfulnessbased cognitive therapy to prevent relapse in recurrent depression. J Consult Clin Psychol, 76:966-978.

Lazarus RS, Alfert E. (1964) Short-circuiting of threat by experimentally altering cognitive appraisal. J Abnorm Soc Psychol, 69:195-205.

Linehan MM (1993) Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guilford. Linehan MM, Bohus M, Lynch TR (2007) Dialectical Behavior Therapy for Pervasive Emotion Dysregulation, Handbook of Emotion Regulation, 1. Baský, JJ Gross (Ed), New York, The Guilford Press, s.581-614.

Lynch TR, Bronner LL (2006) Mindfulness and Dialectical Behaviour Therapy: application with depressed older adults with personality disorders. Mindfulness and Acceptance Based Treatment Approaches, 1. Baský, R. Baer (Ed), USA, Academic Press, s.217-236.

Mennin DS, Heimberg RG, Turk CL ve ark. (2005) Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther, 43:1281-1310.

Mitmansgruber H, Beck TN, Höfer S ve ark. (2009) When you don't like what you feel: experiential avoidance, mindfulness and meta-emotion in emotion regulation. Pers Indiv Differ, 46: 448- 453.

Nolen-Hoeksema S (1991) Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol, 100: 569-582.

Otto MW (2008) Anxiety sensitivity, emotional intolerance, and expansion of the application of interoceptive exposure: commentary on the special issue. J Cogn Psychother, 22: 379-384.

Rachman S & Shafran R (1991) Cognitive distortions: thoughtaction fusion, Clin Psychol Psychother, 6:80-85.

Roemer L, Lee JK, Salters-Pedneault K ve ark. (2008) Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary Evidence for Independent and Overlapping Contributions. Behav Ther, 40:142-154.

Roemer L, Orsillo SM (2002) Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive- behavioural models. Clin Psychol Sci Prac, 9:54-68.

Schmertz SK, Anderson PL, Robins DL (2009) The relation between self-report mindfulness and performance on tasks of sustained attention, J Psychopathol Behav Assess, 31: 60-66.

Segal ZV, Williams JMG, Teasdale JD (2002) Mindfulnessbased Cognitive Therapy for Depression: A New Approach to Preventing Relapse, New York, Guilford Press.

Shapiro, SL, Carlson LE, Astin JA ve ark. (2006) Mechanisms of mindfulness. J Clin Psychol, 62:373-86.

Siegel RD, Germer CK, Olendzki A (2009) Mindfulness: what is it? where did it come from?, Clinical Handbook of Mindfulness, 1. Baskı, F. Didonna (Ed), New York: USA, Springer Publishing, s.17-35.

Teasdale J, Segal Z, Williams J (1995) How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behav Res Ther, 33:25-39.

Teasdale JD (1999) Metacognition, mindfulness and modification of mood disorders. Clin Psychol Psychother, 6: 146-155.

Teasdale JD, Moore RG, Hayhurst H ve ark. (2002) Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol, 70: 275-287

Toneatto T (2002) A metacognitive therapy for anxiety disorders: buddhist psychology applied, Cogn Behav Pract, 9: 72-78.

Walach H, Lynch S, Marie-Louise G (2008) Mindfulness-based coping with university life, (MBCUL): A randomised wait-list controlled study. Eur J Integ Med, 1: 401-41.

Wegner DM (1994) Ironic processes of mental control. Psychol Rev, 101: 34-52.

Wells A (1995) Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behav Cogn Psychother, 23:301- 320.

Wells A (2002) GAD, metacognition, and mindfulness: an information processing analysis. Clin Psychol Sci Pract, 9: 95-100.

Wells A, Matthews G (1996) Modeling cognition in emotional disorder: The S-REF model. Behav Res Ther, 32: 867-870.

Witkiewitz K, Marlatt GA, Walker D (2005) Mindfulness-based relapse prevention for alcohol and substance use disorders. J Cognit Psychother, 19: 211-228.

Wiveka R, Goldin PR, Carmona PA ve ark. (2004) The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognit Ther Res, 28:433-455.

Zvolensky MJ, Sondra ES, Alison CM ve ark. (2006) Incremental validity of mindfulness based attention in relation to the concurrent prediction of anxiety and depressive symptomology and perceptions of health. Cognit Behav Ther, 35:145- 158.

Zylowska L, Ackerman DL, Yang MH ve ark. (2008) Mindfulness meditation training in adults and adolescents with ADHD. J Atten Disord, 11:737-746.

Kaynak Göster