Izazovi u kognitivnoj psihoterapiji hronične depresije

Stefan Jerotić

doi:10.5937/engrami45-47583

Stefan Jerotić Klinika za psihijatriju, Univerzitetski klinički centar Srbije, Beograd, Srbija https://orcid.org/0000-0002-7784-0249

DOI: https://doi.org/10.5937/engrami45-47583

Ključne reči: depresija, psihoterapija, izazovi, kognitivna terapija

Sažetak

Hronična depresija predstavlja psihoterapijski izazov koji zahteva poseban pristup u poređenju sa akutnom depresijom. Psihoterapijski proces koji se zasniva na kognitivno-bihejvioralnoj terapiji mora da uzme u obzir niz specifičnosti ovog stanja, uključujući: (1) izazove u izgradnji terapijskog saveza; (2) izbegavanje kao dominatni mehanizam održavanja; (3) sržna uverenja o samoj depresiji.

Izgradnja terapijskog saveza je često komplikovana dugogodišnjom demoralizacijom pacijenta, koja zahteva poseban senzibilitet i strpljenje terapeuta. Vodeći kognitivni model hronične depresije označava izbegavanje kao jedan od ključnih mehanizama održavanja poremećaja. Izbegavanje se može konceptualizovati u vidu bihejvioralnog, kognitivnog i emocionalnog. Bihejvioralno izbegavanje se manifestuje kao sklonost ka izbegavanju, ili uzdržavanje od suočavanja sa situacijama ili stimulusima iz sredine koji izazivaju nelagodnost. Kognitivno izbegavanje podrazumeva strategije za izbegavanje uznemirujućih misli ili sećanja i može se manifestovati kroz poricanje, preterano uopštavanje, minimiziranje i rumniacije. Emocionalno izbegavanje čini supresija neprijatnih emocionalnih stanja, što često dovodi do sveopšte emocionalne utrnulosti. Mehanizmi izbegavanja su usko isprepletani sa verovanjem osobe o sopstvenoj depresiji. Percepcija postojanja depresije kao znaka lične slabosti ili “biološkog” problema onemogućava povezivanje situacionog konteksta sa simptomima, pojačavajući doživljaj bespomoćnosti. Sveobuhvatni pristup terapiji hronične depresije podrazumeva neophodnost prepoznavanja i adresiranja ovih izazova.

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