Anksiyete Bozukluklarının Tedavisinde İnternet Tabanlı Bilişsel Davranışçı Terapi Uygulamaları

İnternetin yaygın bir sosyal araç olarak kabul edilebilirliğinin artması, internetin psikolojik tedavide bir araç olarak kullanılmasına olanak sağlamıştır. Çevrimiçi iletişim alanının sürekli değişmesi ve gelişmesi ruh sağlığı uzmanlarının çevrimiçi eğitim olanaklarına ulaşmalarını kolaylaştırmış, terapötik müdahaleler için bilgisayarların kullanımını arttırmıştır. İnternet tabanlı sağlanan terapötik müdahalelere baktığımızda yüz yüze terapide olduğu gibi, internet tabanlı terapötik müdahaleler de farklı formatlarda sağlanabilir. Özel tasarlanmış web sayfaları, kendi kendine yardım materyalleri, robot yazılımlar, sanal uygulamalar ve çeşitli koşullarda e-posta, görüntülü konuşmalar ve telefon yoluyla sağlanan terapist destekli çevrimiçi psikoterapi uygulamaları, internet tabanlı Bilişsel Davranışçı Terapi (BDT) için kullanılmaktadır. Bu çalışmada internet tabanlı BDT uygulamalarının Anksiyete Bozukluklarındaki (Toplumsal Kaygı Bozukluğu, Panik Bozukluğu/Agorafobi, Yaygın Kaygı Bozukluğu ve Özgül Fobi) müdahale yöntemleri, etik prensipleri ve uygulama etkililiği, avantaj ve dezavantajları ele alınmıştır. Bu bağlamda araştırma kapsamında internet tabanlı bilişsel davranışçı psikoterapi uygulamaları ile geleneksel yüz yüze BDT müdahaleleri karşılaştırılmıştır. Yapılan derleme; internet tabanlı bilişsel davranışçı psikoterapi uygulamalarının sosyal anksiyete bozukluğunun, panik bozukluğunun (agorafobili veya agorafobisiz), yaygın kaygı bozukluğunun ve özgül fobinin tedavisinde kullanımının giderek arttığını göstermiştir. Anksiyete bozukluklarının tedavisinde internet tabanlı, terapist destekli BDT uygulamaları ve terapist destekli grup uygulamaları; geleneksel yüz yüze terapilerin son dönem alternatifi olarak değerlendirilmiştir. Yapılan bu derlemede, kanıta dayalı internet tabanlı BDT müdahalelerinin, psikolojik hizmet alamayan birçok kişiye erişilebilir olması, düşük maliyetli, etkili ve kabul edilebilir yenilikçi bir yöntem olması sebebiyle dünyada hızla yayılma potansiyeline sahip olduğu görülmüştür.

Anahtar Kelimeler:

İnternet Tabanlı Terapi, Bilişsel Davranışçı Terapi, Çevrimiçi Terapi, Anksiyete Bozuklukları

Internet-Based Cognitive Behavior Therapy in The Treatment of Anxiety Disorders

The increased acceptance of internet as a common social tool, allows the internet to be used as a tool in psychological care. The continuous change and development of the area of online communication has made it easier to access online training opportunities for mental health professionals, increased the use of computers for therapeutic interventions. When we look to the internet-based therapeutic interventions, they can also be provided in different formats, as well as in face-to-face therapy. Web pages, self-help materials, robotic-softwares, virtual-applications and therapist-assisted online psychotherapy applications provided via e-mail, video-calls and telephone in various conditions are used for Internet-based Cognitive Behavioral Therapy (iCBT). In this study, intervention methods, ethical principles and effectiveness of iCBT interventions effectiveness and pros and cons are discussed in Anxiety Disorders (Social Anxiety Disorder, Panic Disorder/Agoraphobia, Generalized Anxiety Disorder, Specific Phobia). In this context, traditional face-to-face CBT interventions and iCBT interventions are compared in the scope of the research. According to this review; iCBT applications, has shown a widespread increasing in the use of treatment of social anxiety disorder, panic disorder (with or without agoraphobia), anxiety disorder and specific phobia. Internet-based, therapist-assisted CBT applications and therapist-assisted group practices are considered to be the recent term alternative of traditional face-to-face therapies in the treatment of anxiety disorders. In this review, evidence-based iCBT intervention, which is effective and acceptable an innovative method, has the potential to spread rapidly throughout the world because of being accessible to many people who cannot receive psychological services and being cost effective.

Keywords:

Internet Based Therapy, Cognitive Behavioral Therapy, Online Therapy, Anxiety Disorders,

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Alaoui, S.E., Hedman, E., Kaldo, V., Hesser, H., Kraepelien, M., F, E., Rück, C., Andersson, G., Ljótsson, B., & Lindefors, N. (2015). Effectiveness of ınternet-based cognitive–behavior therapy for social anxiety disorder in clinical psychiatry. Journal of Consulting and Clinical Psychology. Vol. 83, No. 5, 902–914.
American Psychological Association (1997). APA statement on services by telephone, teleconferencing, and Internet. Retrieved October 8, 2009. http://www.apa.org/ethics/education/ telephone-statement.aspx.
Amerikan Psikiyatri Birliği. (2014). DSM-5 Tanı Ölçütleri: Başvuru Kitabı. Ertuğrul Köroğlu (Çev.). Ankara: Hekimler Yayın Birliği.
Andersson, G. (2016). Internet-delivered psychological treatments. The Annual Review Of Clinical Psychology. 12:12.1–12.23.
Andersson, G., Bergström, J., Buhrman, M., Carlbring, P., Hollandare, F., Kaldo, V., Nilsson-Ihrfelt, E., Paxling, B., Ström, L., & Waara, J. (2008). Development of a new approach to guided self-help via the ınternet: the swedish experience. Journal of Technology in Human Services. Vol. 26 (2-4).
Andersson, G., Carlbring, P., Holmstrom, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E., Buhrman, M., & Ekselius, E. (2006). Internet-based self-help with therapist feedback and ın vivo group exposure for social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology. Vol.74, No:4, 677–686.
Andersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L-G. (2009). Internet-based self-help versus one-session exposure in the treatment of spider phobia: A randomized controlled trial. Cognitive Behaviour Therapy Vol 38, No 2, pp. 114–120.
Andersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L. G. (2013). Internet-based exposure treatment versus one-session exposure treatment of snake phobia: a randomized controlled trial. Cognitive Behaviour Therapy. Vol. 42, No. 4, 284–291,
Andersson,G. (2015). The Internet And Cbt: A Clınıcal Guıde. New York: CRC Press.
Andrews G, Cuijpers P, Craske Mg, Mcevoy P., & Titov N (2010) computer therapy for the anxiety and depressive disorders ıs effective, acceptable and practical health care: a meta-analysis. Plos One 5(10): E13196.
Andrews, G., Basu, A., Cuijpers, P., Craske, MG., McEvoy, P., English, CL., & Newby, JM. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord. 55:70-78.
Andrews, G., Cuijpers, P., Craske, M.G., Mcevoy, P., & Titov, N. (2010) computer therapy for the anxiety and depressive disorders ıs effective, acceptable and practical health care: a meta-analysis. Plos One 5(10).
Barak, A., Klein, B., Proudfoot, J. G. (2009). Defining ınternet-supported therapeutic ınterventions. The Society of Behavioral Medicine, 38:4–17.
Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., Carlbring, P., Andersson, E., & Lindefors, N. (2010). Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry. 10:54.
Boettcher, J., Rozental, A., Andersson, G., & Carlbring, P. (2014). Side effects in Internet-based interventions for Social Anxiety Disorder. Internet Interventions. 1:3–11.
Carlbring, P., Maurin, L., Törngren, C., Linna, E., Eriksson, T., Sparthan, E., Straat, E., Marquez von Hage, C., Bergman-Nordgren, L., & Andersson, G. (2011). Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial. Behaviour Research and Therapy 49:18-24..
Craske, M.G., Stein, M. B., Eley, T.C., Milad. M. R., Holmes, A., Rapee, R. M., & Wittchen, H. U. (2017). Anxiety disorders. Nat Rev Dis Primers. 3:17024.
Cuijpers, P., Marks, İ.M., Straten, A., Cavanagh, K., Gega, L., Andersson, G. (2009). Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cognitive Behaviour Therapy. Vol 38, No 2, pp. 66–82.
Fitzgerald, T. D., Hunter, P. V., & Hadjistavropoulos, T. (2010). Ethical and legal considerations for ınternet-based psychotherapy. Cognitive Behaviour Therapy. Vol. 39, No: 3. 173–187.
Hedman, E., Alaoui, S. E., Lindefors, N., Andersson, E., Rück, C., Ghaderi, A., Kaldo, V., Lekander, M., Andersson, G., & Ljótsson, B. (2014). Clinical effectiveness and cost-effectiveness of Internet- vs. Group-based cognitive behavior therapy for social anxiety disorder: 4-year follow-up of a randomized trial. Behaviour Research and Therapy.
Internet World Stats. (2017). Internet Stats and Facebook Usage in Europe March 2017 Statistics. www.internetworldstats.com/stats4.htm. (30.05.2017).
Johnston, L., Titov, N., Andrews, G., Dear, B. F., & Spence, J. (2013). Comorbidity and ınternet-delivered transdiagnostic cognitive behavioural therapy for anxiety disorders. Cognitive Behaviour Therapy.
Kampmann, I. L., Emmelkamp, P. M. G., & Morina, N. (2016). Meta-analysis of technology-assisted ınterventions for social anxiety disorder. Journal of Anxiety Disorders. (16)30097-4.
Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., & Ciechomski, J. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?.Journal of Anxiety Disorders 22: 1273–1284.
Klein, B., Meyer, D., Austin, D.W., & Kyrios, M. (2011). Anxiety online—a virtual clinic: preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. Journal Of Medıcal Internet Research. 13(4):89.
Lindefors, N., Andersson, G. (Ed.) (2016). Guided Internet-Based Treatments in Psychiatry. Switzerland: Springer International Publishing.
Lindner, P., Ivanova, E., Ly, K. H, Andersson, G., & Carlbring, P. (2013). Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application: study protocol for a randomised controlled trial. Trials. 14:437.
Manhal-Baugus,M. (2001). E-Therapy: Practical, Ethical, And Legal Issues. Cyberpsychology & Behavıor. Volume 4, 5.
Midkiff, D. M., Wyatt, W. J. (2008). Ethical Issues in the Provision of Online Mental Health Services (Etherapy). Journal of Technology in Human Services, 26:2-4.
Schröder, J., Jelinek, L., Moritz, S. (2017). A randomized controlled trial of a transdiagnostic Internet intervention for individuals with panic and phobias e One size fits all. J. Behav. Ther. & Exp. Psychiat. 54:17-24.
Schulz, A., Stolz, T., Vincent, A., Krieger, T., Andersson, G., & Berger, T. ( 2016). A sorrow shared is a sorrow halved? A three-arm randomized controlled trial comparing internet-based clinician-guided individual versus group treatment for social anxiety disorder. Behaviour Research and Therapy 84:14-26.
Spurgeon, J. A., Wright, J. H. (2010). Computer-Assisted Cognitive-Behavioral Therapy. Curr Psychiatry Rep. 12:547–552.
Titov, N., Dear, B,F., Schwencke, G., Andrews, G., Johnston, L., Craske, M. G., & McEvoy, P. (2011). Transdiagnostic internet treatment for anxiety and depression: A randomised controlled trial. Behaviour Research and Therapy 49:441-452.
Titov, N., Dear, B. F., Staples, L. G., Bennett-Levy, J., Klein, B., Rapee, R. M., Shann, C., Richards, D., Andersson, G., Ritterband, L., Purtell, C., Bezuidenhout, G., Johnston, L., & Nielssen, O. B. (2015). MindSpot Clinic: An Accessible, Efficient, and Effective Online Treatment Service for Anxiety and Depression. Psychiatric Services in Advance.
Tulbure, B. T. (2011).The efficacy of Internet-supported intervention for social anxiety disorder: A brief meta-analytic review. Procedia Social and Behavioral Sciences. 30:552 – 557.
Tulbure, B. T., Szentagotai, A., David, O., Ștefan, S., Månsson, K. N. T., David, D., & Andersson, G. (2015). Internet-delivered cognitive-behavioral therapy for social anxiety disorder in romania: a randomized controlled trial. Plos One. May4.
Türk Psikologlar Derneği. (2004). Türk Psikologlar Derneği Etik Yönetmeliği. 18 Nisan 2004 Tarihinde Yapılan 27. Olağan Genel Kurulu.
World Health Organization. (2017). Depression and Other Common Mental Disorders Global Health Estimates. Switzerland.