Özgül Fobilerde Psikofarmakolojik Tedavi
Özet
Özgül fobiler, bireyin işlevselliğini bozan, nesne ya da durumlara karşı ortaya çıkan orantısız korkulardır. En sık görülen anksiyete bozukluğu olmasına rağmen, hastaneye başvuru oranları oldukça düşüktür. Tedavide psikoterapi ve farmakoterapi yöntemleri tek başına ya da kombine şekilde uygulanmaktadır. İlaç tedavisinde serotonin regülasyonunu sağlayan SSRI ve SNRI grubu antidepresanlar yaygın olarak tercih edilirken; erken dönem anksiyetesini azaltmada benzodiazepinlerden, somatik belirtiler için ise beta blokerlerden yararlanılmaktadır. Ayrıca dirençli vakalarda trisiklik antidepresanlar, monoamin oksidaz inhibitörleri ve bilişsel süreçleri destekleyen D-sikloserin gibi ajanlar kullanılabilmektedir. Psikoterapilerde ise maruziyet terapisini içeren bilişsel davranışçı terapi en etkin birinci basamak tedavi yöntemi olarak kabul edilmektedir. Bunun yanı sıra, travmatik anıların beyinde yeniden işlenmesini sağlayan EMDR, bilinç dışına odaklanan hipnoterapi ve hastaya güvenli bir ortamda maruziyet imkanı sunan sanal gerçeklik teknolojisi gibi güncel alternatif yaklaşımlar da tedavideki başarı oranını ve klinik iyileşmeyi önemli ölçüde artırmaktadır.
Specific phobias are disproportionate fears directed toward objects or situations that impair an individual's functionality. Although they are the most common anxiety disorders, hospital admission rates remain significantly low. In treatment, psychotherapy and pharmacotherapy methods are applied either independently or in combination. In pharmacological treatment, SSRI and SNRI group antidepressants, which regulate serotonin, are widely preferred; while benzodiazepines are utilized to reduce early-stage anxiety, and beta-blockers are used for somatic symptoms. Additionally, tricyclic antidepressants, monoamine oxidase inhibitors, and agents that support cognitive processes like D-cycloserine can be employed in resistant cases. In psychotherapies, cognitive behavioral therapy, which incorporates exposure therapy, is recognized as the most effective first-line treatment approach. Alongside this, contemporary alternative approaches—such as EMDR, which enables the reprocessing of traumatic memories in the brain; hypnotherapy, focusing on the subconscious; and virtual reality technology, providing patients with exposure opportunities in a safe environment—significantly increase treatment success rates and clinical recovery.
Referanslar
(Tozun M, Babaoglu AB. Fobiler ve sağlıklı yaşam davranışları: Bir halk sağlığı bakışı. Family Practice Palliative Care. 2016; 1 (1): 24-26
Christophe, A. (2015). Korkunun Psikolojisi. (İsmail YERGUZ, Çev. Ed.). İstanbul: Say Yayınları
Beck, A.T.& Emery, G. (2011). Anksiyete bozuklukları ve fobiler. (Tahir ÖZAKKAŞ, Çev. Ed.). İstanbul: Litera Yayıncılık
Sadock, B.J., Ahmad, S., Sadock, V.A. (2020). Klinik Psikiyatri El Kitabı. (Lut TAMAM, Çev. Ed.). Ankara: Güneş Tıp Kitabevleri
Demirci, O. O., Sağaltıcı, E., & Yıldırım, A. Özgül fobinin göz hareketleri ile duyarsızlaştırma ve yeniden işleme yöntemi ile tedavisi: bir olgu sunumu. Klinik Psikiyatri Dergisi, 18 (4), 124-129.
Muris, P., Van Zwol, L., Huijding, J. Mom told me scary things about this animal: parents installing fear beliefs in their children via the verbal information pathway. Behaviour Research and Therapy, 48 (4), 341-346.
Amerikan Psikiyatri Birliği. (2014). DSM-5 Tanı Ölçütleri Başvuru El Kitabı. (Ertuğrul KÖROĞLU, Çev. Ed.). Ankara: HYB Yayıncılık
Eaton, W.W., Dryman, A., Weissman, M.M. Panic and phobia. In: Robins LN, Regier DA, ed. Psychiatric disorders in America: the Epidemiologic Catchment Area study. New York: The Free Press, 1991: 155–79.
Wardenaar, K.J., Lim, C.C.W., Al-Hamzawi, A.O. The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychological Medicine, 2017; 47: 1744–60.
Oguz, A. Özgül Fobi. Anksiyete Monografları Serisi. 1995; 5(2): 193-204.
Uyan, T. T., Bahçeci, B., & Hocaoğlu, Ç. Gök Gürültüsü Korkusu ‘Brontophobia’: Bir Olgu Sunumu. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, (2018); 8(3), 151-153.
Sungur, M.Z. Fobik Bozukluklar. Psikiyatri Dünyası. 1997; 1(2): 5-11.
Çıtak, S. "Anksiyete bozukluklarında tedavi yaklaşımları: Psikoterapi ve farmakoterapi." Turkiye Klinikleri Family Medicine-Special Topics 9.3 (2018): 141-149.
Benjamin, J., Ben-Zion, I.Z., Karbofsky,.Double-blind placebo-controlled pilot study of paroxetine for specific phobia. Psychopharmacology; (2000) 149: 194-196.
Murphy, T.K., Bengtson, M.A., Tan, J.Y.(2000). Selective serotonin reuptake inhibitors in the treatment of paediatric anxiety disorders: a review. International Clinical Psychopharmacology; (2000) 2: 47- 63.
Thibaut, F. Anxiety disorders: a review of current literature. Dialogues in Clinical Neuroscience, 2017; 19: 87-88.
Bandelow, B., Michaelis, S., Wedekind, D. Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 2017; 19: 93-106.
McCabe, R.E., Swinson, R. Psychotherapy for specific phobia in adults. UpToDate 2016; 16126:1-9.
Stahl, S. M. (2015). Stahl’ın Temel Psikofarmakolojisi. (Tunç ALKIN, Çev. Ed.). İstanbul: İstanbul Tıp Kitabevi
Kwek, T. S. Anxiety Disorders-Assessment and Management in General Practice. The Singapore Family Physician, 2019: 6-12.
Sinclair, L.I., Christmas, D.M., Hood, S.D., et al. Antidepressant-induced jitteriness/anxiety syndrome: systematic review. The British Journal of Psychiatry. (2009) 194: 483–90. doi: 10.1192/bjp.bp.107.048371
Curtiss, J., Andrews, L., Davis, M. Meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators. Expert Opinion Pharmacotherapy. (2017) 18: 243–51. doi: 10.1080/14656566.2017.1285907
American Psychiatric Association. Practice Guideline for the Treatment of Patients with Panic Disorder. Washington, DC (2009)
National Institute for Health and Care Excellence (NICE). Generalised Anxiety Disorder and Panic Disordr in Adults: Management. Available online at: https://www.nice.org.uk/guidance/cg113 (accessed November 13, 2020
National Institute for Health and Care Excellence (NICE). Social Anxiety Disorder: Recognition, Assessment and Treatment. Available online at: https://www.nice.org.uk/guidance/cg159 (accessed November 13, 2020
Garakani, Amir., Murrough, J.W., Freire, R.C., et al. "Pharmacotherapy of anxiety disorders: current and emerging treatment options." Frontiers in psychiatry, (2020): 1412.
Moore, N., Pariente, A., Bégaud, B. Why are benzodiazepines not yet controlled substances? JAMA Psychiatry, (2015) 72:110–1. doi: 10.1001/jamapsychiatry.2014.2190
Raeder, F., Merz, C.J., Tegenthoff, M., et al.: Post-exposure cortisol administration does not augment the success of exposure therapy: A randomized placebo - controlled study. Psychoneuroendocrinology journal, 2019; 99: 174–82.
de Quervain, D.J., Bentz, D., Michael, T., et al. Glucocorticoids enhance extinction-based psychotherapy. Proceedings of the National Academy of Sciences USA 2011; 108: 6621–25.
Soravia, L.M., Heinrichs, M., Winzeler, L., et al. Glucocorticoids enhance in vivo exposure-based therapy of spider phobia. Depression and Anxiety journal, 2014; 31: 429–35.
Ressler, K.J., Rothbaum, B.O., Tannenbaum, L., et al. Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Archives of General Psychiatry, 2004; 61: 1136–44. [PubMed: 15520361]
Lim, L., Chan, H.N., Chew, P.H., et al. Ministry of Health clinical practice guidelines: Anxiety disorders. Singapore medical journal, 2015 Jun; 56(6):310. PMID: 26106237
Türkçapar, H. (2015). Bilişsel Davranışçı Kuramın Psikoterapiye Uygulanması. (9. Baskı). Ankara: HYB Basım Yayın
Choy, Y., Fyer, A.J., Lipsitz, J.D.: Treatment of specific phobia in adults. Clinical Psychology Review, 2007;27(3):266–86. 10.1016/j.cpr.2006.10.002
Wolitzky-Taylor, K.B., Horowitz, J.D., Powers, M.B., et al.: Psychological approaches in the treatment of specific phobias: a meta-analysis. Clinical Psychology Review,. 2008;28(6):1021–37. 10.1016/j.cpr.2008.02.007
Thng, Christabel E.W.,. Lim-Ashworth, Nikki S.J., Poh, Brian Z.Q., et al. "Recent developments in the intervention of specific phobia among adults: A rapid review." F1000Research 9 (2020).
Sadock, B.J., Sadock, V.A. (2005). Kaplan & Sadock’s Klinik Psikiyatri El Kitabı. 8. Baskı.(Hamdullah AYDIN, Ali BOZKURT, Çev. Eds.). Ankara: Güneş Kitabevi
Boehnlein, J., Altegoer, L., Muck, N.K., et al. "Factors influencing the success of exposure therapy for specific phobia: A systematic review." Neuroscience & Biobehavioral Reviews 108 (2020): 796-820.
Bal, F. Göz Hareketleri ile Duyarsızlaştırma ve Yeniden İşleme (EMDR) Yönteminin Psikolojik-Psikiyatrik Kökenli Hastalıkların Tedavisinde Etkinliliği: Sistematik Derleme. Euroasia Journal Of Social Sciencs & Humanities, 2020; 13, 110-116.
Shapiro, F. Eye movement desensitization and reprocessing:Basic principles, protocols and procedures. New York: Guilford Press. (2001).
Oosterink, F. M. D., De Jongh, A., & Aartman, I. H. A. Negative events and their potential risk of precipitating pathological forms of dental anxiety. Journal of Anxiety Disorders, 2009: 23(4), 451–457. doi:10.1016/j.janxdis.2008.09.002
De Jongh, A., Van den Oord, H. J. M., & Ten Broeke, E. Efficacy of eye movement desensitization and reprocessing in the treatment of specific phobias: Four single-case studies on dental phobia. Journal of Clinical Psychology, 2002: 58(12), 1489–1503. doi:10.1002/jclp.10100
Doering, S., Ohlmeier, M. C., De Jongh, A., et al. Efficacy of a trauma-focused treatment approach for dental phobia: A randomized clinical trial. European Journal of Oral Sciences, 2013: 121(6), 584–593. doi:10.1111/eos.12090
Erşan, E.E. Hipnoterapinin Obezite Hastalarındaki Uyku Kalitesine Etkisi. Türk Uyku Tıbbı Dergisi, 2020;1 (7), 16-22.
Elkins, G.R., Barabasz, A.F., Council, J.R., et al. Advancing research and practice: the revised APA Division 30 definition of hypnosis. International Journal of Clinical and Experimental Hypnosis, 2015;63(1):1-9. [Pubmed]
Papagianni, V., & Kotera, Y. The beneficial effects of a single hypnotherapy session using parts negotiation for specific phobias. International Journal of Spa and Wellness, 2022: 1-18.
Halsband, U., & Gerhard Wolf, T. Functional changes in brain activity after hypnosis: Neurobiological mechanisms and application to patients with a specific phobia—Limitations and future directions. International Journal of Clinical and Experimental Hypnosis, 2019: 67(4), 449-474.
Auna, M.S.S. Effect of Hypnotherapy in Reducing Phobia Symptoms. International Journal of Nursing and Midwifery Science (IJNMS), 2020: 4 (1), 29-36.
Baus, O., Bouchard, S. Moving from Virtual Reality Exposure-Based Therapy to Augmented Reality Exposure Based Therapy: A Review. Frontiers in Human Neuroscience. 2014; 8: 112.
Sanchez-Vives, M.V., Slater, M. From presence to consciousness through virtual reality. Nature Reviews Neuroscience. 2005;6:332-9.
Üzümcü, E., Akın, B., Nergiz, H., et al. Anksiyete bozukluklarında sanal gerçeklik. Psikiyatride Güncel Yaklaşımlar, 2018: 10(1), 99-117. doi: 10.18863/pgy.336593
Romano, D.M. (2005). Virtual reality therapy. Developmental Medicine and Child Neurology, 47, 580-580.
Işıklı, S., Baran, Z. ve Aslan, S. Özgül fobilerde sanal gerçeklik teknolojisi uygulamaları ile tedaviye yardımcı araç geliştirme: Bir etkililik çalışması. Klinik Psikiyatri Dergisi, 2019: 22, 316-328. doi: 10.5505/kpd.2019.43660
Parsons, T.D., Rizzo, A.A. Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 2008;39:250-61.
Abdullah, M., & Shaikh, Z. A. An effective virtual reality-based remedy for acrophobia. International Journal of Advanced Computer Science and Applications, 2018: 9 (6), 162-167. doi: 10.14569/IJACSA.2018.090623
Albakri, G., Bouaziz, R., Alharthi, W., et al. Phobia Exposure Therapy Using Virtual and Augmented Reality: A Systematic Review. Applied Sciences, 2022: 12(3), 1672.
