Go to the article page in English / Pojdi na angleško stran članka
Kognitivno-vedenjska obravnava samopoškodbenega vedenja v mladostništvu
Polno besedilo (pdf) | Ogledi: 286 | 
Napisan v slovenščini. | Objavljeno: 27. marec 2020
https://doi.org/10.20419/2020.29.507 | Citati: CrossRef (0)
Povzetek: Namen prispevka je predstaviti kognitivno-vedenjske strategije za obravnavo mladostnic in mladostnikov, ki se samopoškodujejo, kar je lahko v pomoč vsem, ki se v klinični praksi srečujejo s tovrstno problematiko. Samopoškodbeno vedenje je opredeljeno kot samozastrupitev ali samopoškodba in se navadno pojavi med 11. in 15. letom starosti. V obdobju mladostništva je razširjenost tovrstnega vedenja med 12 in 23 %, med klinično populacijo pa je pogostost takega vedenja še večja. Med najmočnejšimi napovedniki tveganja za samopoškodbeno vedenje so psihiatrične bolezni. Mladostniki pogosto poročajo tudi o občutkih kronične praznine, odtujenosti in izolacije, o brezupnosti, nemoči, neljubljenosti, nizki samopodobi in nizki frustracijski toleranci. S samopoškodbenim vedenjem so povezane predvsem težave v uravnavanju čustev ter šibke spretnosti za reševanje problemov. Če mladostniki, ki se samopoškodujejo, ne poiščejo pomoči, se lahko samopoškodbeno vedenje stopnjuje v svoji resnosti, ter hkrati predstavlja močan napovednik tveganja za samomor, zaradi česar je obravnava tovrstnega vedenja izrednega pomena. Pri obravnavi samopoškodbenega vedenja se je kognitivno-vedenjska terapija izkazala kot eden izmed učinkovitih ukrepov. Znotraj obravnave je poudarek na uravnavanju čustev, obravnavi disfunkcionalnih misli in prepričanj, okrepitvi na področju vedenjskih spretnosti (kot je reševanje problemov) ter izboljšanju medosebnih odnosov, hkrati pa poudarjamo tudi sprejemajoč, čuječ odnos do sebe in do lastne preteklosti. Raziskave kažejo, da so mladostniki po obravnavi poročali o manj pogostem samopoškodbenem vedenju in samomorilnih mislih, hkrati pa so se zmanjšali tudi simptomi depresivnosti in anksioznosti, izboljšala se je samopodoba, mladostniki so bolje uravnavali svoja čustva in težave ustrezneje reševali.
Ključne besede: samopoškodbeno vedenje, mladostništvo, kognitivno-vedenjska terapija, uravnavanje čustev, reševanje problemov
Citiraj:
Dolenc, B. (2020). Kognitivno-vedenjska obravnava samopoškodbenega vedenja v mladostništvu [Cognitive-behavioural therapy of deliberate self-harm in adolescence]. Psihološka obzorja, 29, 21–31. https://doi.org/10.20419/2020.29.507
Seznam literature v članku
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Arlington: American Psychiatric Publishing. CrossRef
Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., ... in Brent, D. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA trial. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 772–781. CrossRef
Berk, M. S., Henriques, G. R., Warman, D. M., Brown, G. K. in Beck, A. T. (2004). A cognitive therapy intervention for suicide attempters: An overview of the treatment and case examples. Cognitive and Behavioral Practice, 11(3), 265–277. CrossRef
Blakemore, S. J. (2008). The social brain in adolescence. Nature Reviews Neuroscience, 9(4), 267–277. CrossRef
Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E. in Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts. A randomized controlled trial. Journal of the American Medical Association, 294(5), 563–570. CrossRef
Brown, S. L. in Vinokur, A. D. (2003). The interplay among risk factors for suicidal ideation and suicide: the role of depression, poor health, and loved ones' messages of support and criticism. American Journal of Community Psychology, 32(1-2), 131–141. CrossRef
Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., Appleby, L. (2005). Suicide after deliberate self-harm: A 4-year cohort study. American Journal of Psychiatry, 162(2), 297–303. CrossRef
Evans, E., Hawton, K. in Rodham, K. (2005). Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse and Neglect, 29(1), 45–58. CrossRef
Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C. in Schulz, E. (2011). Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health, 5(1), 3. CrossRef
Gonzales, A. H. in Bergstrom, L. (2013). Adolescent Non-Suicidal Self-Injury (NSSI) Interventions. Journal of Child and Adolescent Psychiatric Nursing, 26(2), 124–130. CrossRef
Gratz, K. L. (2001). Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253–263. CrossRef
Hankin, B. L. in Abela, J. R. (2011). Nonsuicidal self-injury in adolescence: prospective rates and risk factors in a 2(1/2) year longitudinal study. Psychiatry Research, 186(1), 65–70. CrossRef
Harrington, R., Pickles, A., Aglan, A., Harrington, V., Burroughs, H. in Kerfoot, M. (2005). Early adult outcomes of adolescents who deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 337–345. CrossRef
Hawton, K. in James, A. (2005). Suicide and deliberate selfharm in adolescents. British Medical Journal, 33, 891–894. CrossRef
Hawton, K., O'Connor, R. C. in Saunders, K. E. A. (2015). Suicidal behavior and self-harm. V A. Thapar, D. S. Pine, Lockman, J. F., Scott, S., Snowling, M. J. in Taylor, E. (ur.), Rutter's Child and Adolescent Psychiatry, 6th ed. (str. 893–912). Chichester: John Wiley and Sons Ltd. CrossRef
Hawton, K., Rodham, K., Evans, E. in Weatherall, R. (2002). Deliberate self-harm in adolescents: self report survey in schools in England. British Medical Journal, 325(7374), 1207–1211. CrossRef
Hawton, K., Zahl, D. in Weatherall, R. (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542. CrossRef
Jacobson, C. M. in Gould, M. (2007). The epidemiology and phenomenology of nonsuicidal self-injurious behavior among adolescents: a critical review of the literature. Archives of Suicide Research, 11(2), 129–147. CrossRef
Kamphuis, J. H., Ruyling, S. B. in Reijntjes, A. H. (2007). Testing the emotion regulation hypothesis among self-injuring females: Evidence for differences across mood states. The Journal of Nervous and Mental Disease, 195(11), 912–918. CrossRef
King, R. A., Shwab-Stone, M., Flisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H., ... in Gould, M. S. (2001) Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7), 837–846. CrossRef
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guilford Press.
Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L. in Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18(3), 303–312. CrossRef
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., ... in Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. CrossRef
Lloyd-Richardson, E. E., Perrine, N., Dierker, L. in Kelley, M. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192. CrossRef
Madge, N., Hawton, K., McMahon, E. M., Corcoran, P., De Leo, D., de Wilde, E. J., ... in Arensman, E. (2011). Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. European Child and Adolescent Psychiatry, 20(19), 499–508. CrossRef
McAuliffe, C., Corcoran, P., Keeley, H. S., Arensman, E., Bille-Brahe, U., De Leo, D., ... in Wasserman, D. (2006). Problem solving ability and repetition of deliberate self-harm: a multicentre study. Psychological Medicine, 36(1), 45–55. CrossRef
Muehlenkamp, J. J. (2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28(2), 166–185. CrossRef
National Institutte for Health and Care Excellence, NICE (2004). Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Leucester (UK): The British Psychological Society.
Nixon, M. K., Levesque, C., Preye, M., Vanderkooy, J. in Clouties, P. F. (2015). The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents. Child and Adolescent Psychiatry and Mental Health, 9, 26. CrossRef
Nock, M. K., Holmberg, E. B., Photos, V. I. in Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. CrossRef
O'Connor, R. C. (2003). Suicidal behavior as a cry of pain: Test of a psychological model. Archives of Suicide Research, 7(4), 297–308. CrossRef
Orbach, I., Mikulincer, M., Gilboa-Schechtman, E. in Sirota, P. (2003). Mental pain and its relationship to suicidality and life meaning. Suicide & Life-Threatening Behavior, 33(3), 231–241. CrossRef
Ougrin, D., Tranah, T., Leigh, E., Taylor, L. in Asarnow, J. R. (2012). Practitioner Review: Self-harm in adolescents. Journal of Child Psychology and Psychiatry, 53(4), 337–350. CrossRef
Ougrin, D., Tranah, T., Stahl, D., Moran, P. in Asarnow, J. R. (2015). Therapeutic Interventions for Suicide Attempts and Self-Harm in Adolescents: Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54(2), 97–107. CrossRef
Perepletchikova, F., Axelrod, S. R., Kaufman, J., Rounsaville, B. J., Douglas-Palumberi, H. in Miller, A. L. (2011). Adapting dialectical behaviour therapy for children: towards a new research agenda for paediatric suicidal and non-suicidal self-injurious behaviours. Child and Adolescent Mental Health, 16(2), 116–121. CrossRef
Rodham, K., Hawton, K. in Evans, E. (2004). Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(1), 80–87. CrossRef
Rudd, M. D. (2004). Cognitive therapy for suicidality: An integrative, comprehensive, and practical approach to conceptualization. Journal of Contemporary Psychotherapy, 34(1), 59–72. CrossRef
Rudd, M. D., Joiner, T. in Rajab, M. H. (2001). Treating suicidal behaviour. An effective, timelimited approach. New York: The Guilford Press.
Slee, N., Arensman, E., Garnefski, N. in Spinhoven, P. (2007). Cognitive-behavioral therapy for deliberate self-harm. Crisis, 28(4), 175–182. CrossRef
Slee, N., Garnefski, N. in Spinhoven, P. (2008). Treatment protocol for deliberate self-harm in adolescents and adults. V N. Slee (ur.), Cognitive-behavioural therapy for deliberate self-harm (str. 31-53). Enschede: PrintPartners Ipskamp.
Slee, N., Garnefski, N., Spinhoven, P. in Arensman, E. (2008). The influence of cognitive emotion regulation strategies and depression severity on deliberate self-harm. Suicide and Life-Threatening Behavior, 28(3), 274–286. CrossRef
Slee, N., Garnefski, N., van der Leeden, R., Arensman, E. in Spinhoven, P. (2008). Cognitive-behavioural intervention for self-harm: randomised controlled trial. The British Journal of Psychiatry, 192(3), 202–211. CrossRef
Slee, N., Spinhoven, P., Garnefski, N. in Arensman, E. (2008). Emotion regulation as mediator of treatment outcome in therapy for deliberate self-harm. Clinical Psychology and Psychotherapy, 15(4), 205–216. CrossRef
Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., ... in Van Heerugen, K. (2001). The efficacy of problem solving treatments after deliberate self-harm: metaanalysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine, 31(6), 979–988. CrossRef
Washburn, J. J., Juzwin, K. R., Styer, D. M. in Aldridge, D. (2010). Measuring the urge to self-injure: preliminary data from a clinical sample. Psychiatry Research, 178(3), 540–544. CrossRef
Washburn, J., Richardt, S. L., Styer, D. M., Gebhardt, M., Juzwin, K. R., Yourek, A. in Aldridge, D. (2012). Psychotherapeutic approaches to non-suicidal self-injury in adolescents. Child and Adolescent Psychiatry and Mental Health, 6, 14. CrossRef
Williams, J. M. G., Duggan, D. S., Crane, C. in Fennell, M. J. V. (2006). Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. Journal of Clinical Psychology, 62(2), 201–210. CrossRef
