Kofnitivně Behaviorální Terapie V Léčbě Mentální Anorexie

2030 words - 9 pages

V této práci se budu zabývat využitím kognitivně-behaviorální terapie k léčbě mentální anorexie. Nejprve stručně popíši toto onemocnění, poté se pokusím charakterizovat specifika kognitivně-behaviorální terapie v léčbě mentální anorexie a v poslední části této práce představím pět výzkumů, které se snažily prokázat účinnost této léčby.
Mentální anorexie
Mentální anorexie je porucha charakterizována úmyslným zhubnutím‚ které si pacient sám vyvolal a dále jej udržuje. Tělesná váha je zachovávána nejméně 15 % pod předpokládanou váhou (ať již byla snížena nebo jí nikdy nebylo dosaženo) či je BMI 17,5 a méně. Objevuje se nejčastěji u adolescentních dívek a mladých žen‚ avšak i dospívající ...view middle of the document...

Kognitivně-behaviorální terapie v léčbě mentální anorexie
KBT se zaměřuje na konkrétní, pozorovatelné a jasně definovatelné problémy. Terapeut by měl zaujímat aktivní, v některých případech až direktivní roli, ale současně být otevřený a kooperativní. Pacienta průběžně motivuje a vede k aktivní spoluúčasti v řešení problémů. Významnou roli v terapii hraje sebemonitorování, aktivní nácvik, konfrontace se zúskostňujícími podněty a domácí cvičení. KBT se opírá o poznatky teorie učení a kognitivní psychologie, stejně tak jako o dobrou znalost problematiky poruch přijmu potravy. Prvořadým cílem je potlačení faktorů udržujících poruchu a přerušení nevhodných návyků pacienta (Papežová, 2010).
Výzkumy
McIntosh a kolegové (2005) porovnávali účinnost KBT a interpersonální psychoterapie (dále IPT) s kontrolní léčbou. Studie se zúčastnilo 56 žen ve věku od 17 do 40 let, které splňovaly diagnostická kritéria DSM-IV pro mentální anorexii. Ženy byly náhodně rozděleny do tří skupin. Jedna skupina absolvovala kognitivně-behaviorální terapii, druhá interpersonální terapii a poslední kontrolní skupina absolvovala Specialist supportive clinical management for anorexia nervosa (dále SSCM). Tento přístup byl speciálně vyvinut pro tuto studii. Měl co nejvěrněji napodobovat ambulantní léčbu, která je obvykle využívána v klinické praxi. Cílem tohoto přístupu bylo zaměřit se na stav výživy a stravovací zvyklosti typické pro mentální anorexii. Každá terapie obsahovala minimálně 20 sezení za 20 měsíců. První hodnoty byly naměřeny před terapií a druhé následně po terapii. Měření mělo několik částí: první byla čtyřbodová pořadové stupnice měřící závažnost onemocnění, dále participanti vyplnily Eating Disorder Examination (EDE), který zjišťoval výšku, váhu a psychický stav. Poté byl použitý dotazník Eating Disorders Inventory-2 (EDI21) zkoumající bažení po vyhublém těle, bulimii, nespokojenost s vlastním tělem, perfekcionizmus, nedůvěru atd. The Global Assessment of Functioning (GAF; DSM-IV22 p.32) and the Hamilton Depression Rating Scale (HDRS23). Z celkových 56 žen ukončilo léčbu 43. Byl zjištěn významný rozdíl v průměrné hmotnosti mezi těmi, kdo léčbu ukončil a kdo z léčby odešel. Mezi jednotlivými skupinami nebyl nalezen žádný významný rozdíl (McIntosh, a další, 2005).
Na tento výzkum navázal Carter a jeho kolegové (2011). Ti zkoumali ten samý vzorek, ale po průměrně 6,7 letech (nejméně však po 5 letech) od ukončení léčby. Zajímal je tedy dlouhodobý účinek výše zmínených terapií. Výzkumníci nezjistili žádné zásadní rozdílnosti mezi konkrétními terapiemi. U téměř poloviny participantů došlo v průběhu dlouhodobé léčby k signifikantnímu zlepšení. U všech druhů léčby došlo ke zvýšení hmotnosti a BMI. Výzkum ale naznačuje, že kokrétní léčebné postupy (KBT a TPT) jsou spojeny s dlouhodobě pozitivnějšími výsledky (Carter, a další, 2011).
V další studii porovnával Carter (2009) léčbu kognitivně-behaviorální terapie s obvyklou léčbou (Treatment as Usual). Studie se...

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