Kumar sorunu olan bireylerde kumarla ilgili bilişlerin kumar oynama, depresyon şiddeti ve tedavi motivasyonu ile ilişkisi
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Dosyalar
Tarih
2021
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ Kumar oynama bozukluğu önemli psikolojik, sosyal ve ekonomik sorunlara yol açan bir psikiyatrik bozukluktur. Bilişsel çarpıtmalar kumar oynama bozukluğunun oluşumunda ve sürmesinde rol oynayan önemli etkenlerden birisidir. Kumar oynama bozukluğunun tedavisinde etkinliği kanıtlanmış bir yöntem olan bilişsel davranışçı terapi, bu çarpık bilişlere odaklanmaktadır. Bununla birlikte kumar sorunu olan bireylerin tedaviye başvuru oranlarının düşük olduğu bilinmektedir. Psikiyatrik ektanılar bu grupta oldukça sık görülmekte, özellikle major depresif bozukluk tablosuna sıklıkla rastlanmakta, gerek kumar oynama şiddeti gerekse bilişsel çarpıtmalarla yakın ilişki göstermektedir. Literatürde kumar sorunu olan bireylerin tedavi motivasyonlarını inceleyen çalışmalar olmakla birlikte bilişsel çarpıtmalar ve depresyonun tedavi motivasyonuna etkilerini araştıran sınırlı sayıda çalışma vardır.
AMAÇ Çalışmanın amacı, kumar oynama sorunu olan bireylerin tedavi motivasyonlarına etki eden faktörleri belirlemek, eşlik eden depresyonun ve kumarla ilgili bilişsel çarpıtmaların saptanarak tedavi sürecinde hedef alınabilecek bir tedavi stratejisi geliştirmek ve literature katkıda bulunmaktır.
YÖNTEM Çalışmaya kumar oynama sorunu nedeniyle başvuran 60 kişi alınmıştır. Kişilere SCID-5 CV ve Hamilton Depresyon Derecelendirme Ölçeği uygulanmış, kumar sorunu ile ilgili kendilerinden ve yakınlarından öykü alınmıştır. Ardından olgu rapor formu doldurulmuş ve kişilerden South Oaks Kumar Tarama Testi, Kumar ile İlgili Düşünceler Ölçeği ve Tedavi Motivasyon Anketi’ni doldurmaları istenmiştir.
BULGULAR HAM-D puanı ile SOKTT puanı (r: 0,280 p:0,03) ve KDÖ kumar oynamayı durduramama alt ölçeği puanları (r: 0,319 p:0,013) arasında pozitif korelasyon; TMA tedaviye güven alt ölçeği puanı (r: -0,270 p: 0,037) arasında negatif korelasyon saptanmıştır. SOKTT puanı ile KDÖ kumar oynama beklentileri alt ölçeği puanı (r: 0,303 p:0,019), KDÖ yoruma dayalı önyargı alt ölçeği puanı (r: 0,270 p:0,037) ve TMA dışsal motivasyon alt ölçeği puanı (r: 0,266 p: 0,040) arasında pozitif korelasyon saptanmıştır.
SONUÇ Çalışmanın sonucunda artmış depresyon şiddetinin kumar oynama şiddetini artırdığı, daha fazla sayıda kumar oynamayla ilgili bilişsel çarpıtma ile ilişkili olduğu ve özellikle kumar oynamayı bırakamama ile ilgili algılanan öz yetersizlikle bağlantılı olduğu, tedaviye güveni azalttığı saptanmıştır. Kumar oynama şiddeti ile özellikle kumar oynama beklentileri ve yoruma dayalı önyargı alanındaki bilişsel çarpıtmaların ilişki gösterdiği, ayrıca kumar oynama şiddeti arttıkça kişilerin tedaviye başvuru yönünde algıladıkları dışsal baskının arttığı görülmüştür. Sonuç olarak tedaviye başvuran olgular tedavi motivasyon seviyeleri, ek psikopatoloji açısından değerlendirilmeli ve kumarla ilgili bilişsel çarpıtmalar sorgulanıp terapi esnasında anlamları ve geçerlilikleri sorgulanarak müdahale edilmelidir. Daha büyük örneklemde, uzunlamasına izlem çalışmalarının, bulguların genellenebilirliği ve klinik pratiğe yansımalarının değerlendirilmesi açısından gerekli olacağı düşünülmektedir.
INTRODUCTION Gambling disorder is a psychiatric disorder that causes significant psychological, social and economic problems. Cognitive distortions are one of the important factors that play a role in the formation and maintenance of gambling disorder. Cognitive behavioral therapy, a proven method in the treatment of gambling disorder, focuses on these distorted cognitions. However, it is known that the rate of reference to treatment is low for individuals with gambling problems. Psychiatric comorbidities are quite common in this group, especially major depressive disorder is frequently encountered, and they are closely related to both the severity of gambling and cognitive distortions. Although there are studies in the literature that examine the treatment motivations of individuals with gambling problems, there are a limited number of studies investigating the effects of cognitive distortions and depression on treatment motivation. AIM The aim of the study is to determine the factors affecting the treatment motivation of individuals with gambling problems, to identify accompanying depression and cognitive distortions related to gambling, to develop a treatment strategy that can be targeted during the treatment process and to contribute to the literature. METHOD 60 patients who applied for gambling problems were included in the study. SCID-5 CV and Hamilton Depression Rating Scale were applied to the individuals, and a history of gambling problem was taken from them and their relatives. Then, the case report form was filled out and the individuals were asked to fill the South Oaks Gambling Screening Test, the Gambling Related Cognitions Scale and the Treatment Motivation Questionnaire. RESULTS A positive correlation was found between the HAM-D score and the SOGS score (r: 0.280 p: 0.03) and the GRCS inability to stop gambling subscale scores (r: 0.319 p: 0.013). A negative correlation was found between the HAM-D score and TMQ treatment confidence subscale score (r: -0.270 p: 0.037). A positive correlation between the SOGS score and the GRCS gambling expectations subscale score (r: 0.303 p: 0.019), the interpretative bias subscale score (r: 0.270 p: 0.037) and the TMQ extrinsic motivation subscale score (r: 0.266 p: 0.040). CONCLUSION As a result of the study, it was found that increased depression severity increased the severity of gambling, was associated with a greater number of cognitive distortions related to gambling, and was associated with perceived self-inadequacy, especially in not being able to quit gambling, and reduced confidence in treatment. It was observed that gambling severity was associated with cognitive distortions, especially in the field of gambling expectations and interpretative bias, and as the severity of gambling increased, the external pressure perceived by individuals to seek treatment increased. In conclusion, patients applying for treatment should be evaluated in terms of their treatment motivation levels, additional psychopathology, and cognitive distortions related to gambling should be questioned and intervened during therapy by questioning their meaning and validity. It is thought that longitudinal follow-up studies with a larger sample will be necessary in terms of evaluating the generalizability of the findings and their reflections on clinical practice.
INTRODUCTION Gambling disorder is a psychiatric disorder that causes significant psychological, social and economic problems. Cognitive distortions are one of the important factors that play a role in the formation and maintenance of gambling disorder. Cognitive behavioral therapy, a proven method in the treatment of gambling disorder, focuses on these distorted cognitions. However, it is known that the rate of reference to treatment is low for individuals with gambling problems. Psychiatric comorbidities are quite common in this group, especially major depressive disorder is frequently encountered, and they are closely related to both the severity of gambling and cognitive distortions. Although there are studies in the literature that examine the treatment motivations of individuals with gambling problems, there are a limited number of studies investigating the effects of cognitive distortions and depression on treatment motivation. AIM The aim of the study is to determine the factors affecting the treatment motivation of individuals with gambling problems, to identify accompanying depression and cognitive distortions related to gambling, to develop a treatment strategy that can be targeted during the treatment process and to contribute to the literature. METHOD 60 patients who applied for gambling problems were included in the study. SCID-5 CV and Hamilton Depression Rating Scale were applied to the individuals, and a history of gambling problem was taken from them and their relatives. Then, the case report form was filled out and the individuals were asked to fill the South Oaks Gambling Screening Test, the Gambling Related Cognitions Scale and the Treatment Motivation Questionnaire. RESULTS A positive correlation was found between the HAM-D score and the SOGS score (r: 0.280 p: 0.03) and the GRCS inability to stop gambling subscale scores (r: 0.319 p: 0.013). A negative correlation was found between the HAM-D score and TMQ treatment confidence subscale score (r: -0.270 p: 0.037). A positive correlation between the SOGS score and the GRCS gambling expectations subscale score (r: 0.303 p: 0.019), the interpretative bias subscale score (r: 0.270 p: 0.037) and the TMQ extrinsic motivation subscale score (r: 0.266 p: 0.040). CONCLUSION As a result of the study, it was found that increased depression severity increased the severity of gambling, was associated with a greater number of cognitive distortions related to gambling, and was associated with perceived self-inadequacy, especially in not being able to quit gambling, and reduced confidence in treatment. It was observed that gambling severity was associated with cognitive distortions, especially in the field of gambling expectations and interpretative bias, and as the severity of gambling increased, the external pressure perceived by individuals to seek treatment increased. In conclusion, patients applying for treatment should be evaluated in terms of their treatment motivation levels, additional psychopathology, and cognitive distortions related to gambling should be questioned and intervened during therapy by questioning their meaning and validity. It is thought that longitudinal follow-up studies with a larger sample will be necessary in terms of evaluating the generalizability of the findings and their reflections on clinical practice.
Açıklama
Anahtar Kelimeler
Bilişsel Çarpıtma, Depresyon, Kumar Oynama Bozukluğu, Patolojik Kumar, Tedavi Motivasyonu, Cognitive Distortions, Gambling Disorder, Depression, Treatment Motivation
