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2019 | OriginalPaper | Hoofdstuk

8. Cognitieve therapie bij dwangstoornis

Auteurs : prof. dr. Patricia van Oppen, dr. Henny Visser

Gepubliceerd in: Cognitieve therapie

Uitgeverij: Bohn Stafleu van Loghum

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Samenvatting

Dit hoofdstuk gaat over cognitieve interventies bij de behandeling van de obsessief-compulsieve stoornis, oftewel de dwangstoornis. Aan de hand van veel casuïstiek komen de belangrijkste stappen in de behandeling aan bod: het behandelcontract, de rationale, het opsporen en uitdagen van catastrofale gedachten en het uitvoeren van gedragsexperimenten. Daarnaast bespreken we veelvoorkomende thema’s die bij de dwangstoornis een belangrijke rol lijken te spelen, zoals de overschatting van de eigen verantwoordelijkheid en de overschatting van gevaar. Tot slot wordt een overzicht gegeven van onderzoek met betrekking tot de effectiviteit van cognitieve therapie bij de dwangstoornis.
Literatuur
go back to reference Abramowitz, J. (2018). Presidential Address: Are the obsessive compulsive related disorders related to obsessive-compulsive disorder? A critical Look at DSM-5’s new category. Behavior Therapy, 49, 1–11.PubMedCrossRef Abramowitz, J. (2018). Presidential Address: Are the obsessive compulsive related disorders related to obsessive-compulsive disorder? A critical Look at DSM-5’s new category. Behavior Therapy, 49, 1–11.PubMedCrossRef
go back to reference Alcolado, G. M., & Randomsky, A. S. (2016). A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory. Journal of Behavior therapy and Experimental Psychiatry, 53, 75–83.PubMedCrossRef Alcolado, G. M., & Randomsky, A. S. (2016). A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory. Journal of Behavior therapy and Experimental Psychiatry, 53, 75–83.PubMedCrossRef
go back to reference American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: APA.CrossRef American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: APA.CrossRef
go back to reference Anholt, G. E., Aderka, I. M., van Balkom, A. J. L. M., Smit, J. H., Schruers, K., van de Wee, N. J. A., et al. (2014). Age at onset in obsessive-compulsive disorder: Admixture analysis with a large sample. Psychological Medicine, 1, 185–194.CrossRef Anholt, G. E., Aderka, I. M., van Balkom, A. J. L. M., Smit, J. H., Schruers, K., van de Wee, N. J. A., et al. (2014). Age at onset in obsessive-compulsive disorder: Admixture analysis with a large sample. Psychological Medicine, 1, 185–194.CrossRef
go back to reference Arntz, A., Voncken, M., & Goosen, A. C. A. (2007). Responsibility and obsessive-compulsive disorder: An experimental test. Behaviour Research and Therapy, 45, 425–435.PubMedCrossRef Arntz, A., Voncken, M., & Goosen, A. C. A. (2007). Responsibility and obsessive-compulsive disorder: An experimental test. Behaviour Research and Therapy, 45, 425–435.PubMedCrossRef
go back to reference Boschen, M. J., & Vuksanovic, D. (2007). Deteriorating memory confidence, responsibility perceptions and repeated checking: Comparisons in OCD and control samples. Behaviour Research and Therapy, 45(9), 2098–2109.PubMedCrossRef Boschen, M. J., & Vuksanovic, D. (2007). Deteriorating memory confidence, responsibility perceptions and repeated checking: Comparisons in OCD and control samples. Behaviour Research and Therapy, 45(9), 2098–2109.PubMedCrossRef
go back to reference Bouvard, M., Fournet, N., Denis, A., Sixdenier, A., & Clark, D. (2017). Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: A comparison using the International Intrusive Thought Interview Schedule. Cognitive Behaviour Therapy, 46(4), 287–299.PubMedCrossRef Bouvard, M., Fournet, N., Denis, A., Sixdenier, A., & Clark, D. (2017). Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: A comparison using the International Intrusive Thought Interview Schedule. Cognitive Behaviour Therapy, 46(4), 287–299.PubMedCrossRef
go back to reference Carr, A. T. (1974). Compulsive neuroses: A review of the literature. Psychological Bulletin, 81, 311–318.PubMedCrossRef Carr, A. T. (1974). Compulsive neuroses: A review of the literature. Psychological Bulletin, 81, 311–318.PubMedCrossRef
go back to reference Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders. Science and practice. New York: Guilford Press. Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders. Science and practice. New York: Guilford Press.
go back to reference Diefenbach, G. J., Abramowitz, J. S., Norberg, M. M., & Tolin, D. F. (2007). Changes in quality of life following cognitive behavioral therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 3060–3068.PubMedCrossRef Diefenbach, G. J., Abramowitz, J. S., Norberg, M. M., & Tolin, D. F. (2007). Changes in quality of life following cognitive behavioral therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 3060–3068.PubMedCrossRef
go back to reference Freeston, M. H., Ladouceur, R., Gagnon, F., & Thibodeau, N. (1991). Cognitive intrusions in a non-clinical population. I. Response style, subjective experience and appraisal. Behaviour Research and Therapy, 29, 585–597.PubMedCrossRef Freeston, M. H., Ladouceur, R., Gagnon, F., & Thibodeau, N. (1991). Cognitive intrusions in a non-clinical population. I. Response style, subjective experience and appraisal. Behaviour Research and Therapy, 29, 585–597.PubMedCrossRef
go back to reference Freeston, M. H., Rhéaume, J., & Ladouceur, R. (1996). Correcting faulty appraisals of obsessional thoughts. Behaviour Research and Therapy, 34, 433–446.PubMedCrossRef Freeston, M. H., Rhéaume, J., & Ladouceur, R. (1996). Correcting faulty appraisals of obsessional thoughts. Behaviour Research and Therapy, 34, 433–446.PubMedCrossRef
go back to reference Geraerts, E., Merckelbach, H., Jelicic, M., & Smeets, E. (2006). Long term consequences of intrusive anxious thoughts and repressive coping. Behaviour Research and Therapy, 44, 1451–1460.PubMedCrossRef Geraerts, E., Merckelbach, H., Jelicic, M., & Smeets, E. (2006). Long term consequences of intrusive anxious thoughts and repressive coping. Behaviour Research and Therapy, 44, 1451–1460.PubMedCrossRef
go back to reference Julien, D., O’Connor, K., & Aardema, F. (2007). Intrusive thoughts, obsessions, and appraisals in obsessive-compulsive disorder: A critical review. Clinical Psychology Review, 27, 366–383.PubMedCrossRef Julien, D., O’Connor, K., & Aardema, F. (2007). Intrusive thoughts, obsessions, and appraisals in obsessive-compulsive disorder: A critical review. Clinical Psychology Review, 27, 366–383.PubMedCrossRef
go back to reference Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.PubMedCrossRef Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.PubMedCrossRef
go back to reference Lavy, E., & van den Hout, M. (1990). Thought suppression induces intrusions. Behavioural Psychotherapy, 18, 251–258.CrossRef Lavy, E., & van den Hout, M. (1990). Thought suppression induces intrusions. Behavioural Psychotherapy, 18, 251–258.CrossRef
go back to reference Lopatka, C., & Rachman, S. (1995). Perceived responsibility and compulsive checking: An experimental analysis. Behaviour Research and Therapy, 33, 673–684.PubMedCrossRef Lopatka, C., & Rachman, S. (1995). Perceived responsibility and compulsive checking: An experimental analysis. Behaviour Research and Therapy, 33, 673–684.PubMedCrossRef
go back to reference McFall, M. E., & Wollersheim, J. P. (1979). Obsessive-compulsive neurosis: A cognitive-behavioral formulation and approach to treatment. Cognitive Therapy and Research, 3, 333–348.CrossRef McFall, M. E., & Wollersheim, J. P. (1979). Obsessive-compulsive neurosis: A cognitive-behavioral formulation and approach to treatment. Cognitive Therapy and Research, 3, 333–348.CrossRef
go back to reference McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., et al. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research, 227(1), 104–113.PubMedCrossRef McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., et al. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research, 227(1), 104–113.PubMedCrossRef
go back to reference Melli, G., Carraresi, C., Poli, A., Marazzitti, D., & Pinto, A. (2016). The role of guilt sensitivity in OCD symptom dimension. Clinical Psychology and Psychotherapy, 24, 1079–1089.CrossRef Melli, G., Carraresi, C., Poli, A., Marazzitti, D., & Pinto, A. (2016). The role of guilt sensitivity in OCD symptom dimension. Clinical Psychology and Psychotherapy, 24, 1079–1089.CrossRef
go back to reference Morillo, C., Belloch, A., & Carcia-Soranio, G. (2007). Clinical opbsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious patients: Where are the differences? Behaviour Research and Therapy, 45, 1319–1333.PubMedCrossRef Morillo, C., Belloch, A., & Carcia-Soranio, G. (2007). Clinical opbsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious patients: Where are the differences? Behaviour Research and Therapy, 45, 1319–1333.PubMedCrossRef
go back to reference Multidisciplinaire Richtlijn Angststoornissen. (Derde revisie, 2013). Richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen patiënten met een angststoornis. Utrecht: Trimbos-instituut. Multidisciplinaire Richtlijn Angststoornissen. (Derde revisie, 2013). Richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen patiënten met een angststoornis. Utrecht: Trimbos-instituut.
go back to reference Norberg, M. M., Calamari, J. E., Cohen, R. J., & Riemann, B. C. (2008). Quality of life in obsessive compulsive disorder: An evaluation of impairment and a preliminairy analysis of the ameliorating effects of treatment. Depression and Anxiety, 25, 248–259.PubMedCrossRef Norberg, M. M., Calamari, J. E., Cohen, R. J., & Riemann, B. C. (2008). Quality of life in obsessive compulsive disorder: An evaluation of impairment and a preliminairy analysis of the ameliorating effects of treatment. Depression and Anxiety, 25, 248–259.PubMedCrossRef
go back to reference Obsessive Compulsive Cognitions Working Group (OCCWG). (2001). Development and initial validation of the obsessive beliefs questionaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006.CrossRef Obsessive Compulsive Cognitions Working Group (OCCWG). (2001). Development and initial validation of the obsessive beliefs questionaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006.CrossRef
go back to reference Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015) Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40(2015), 56–69. Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015) Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40(2015), 56–69.
go back to reference Öst, L. G., Riise, E. N., Wergeland, G. J., Hansen, B., & Kvale, G. (2016). Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. Journal of Anxiety Disorders, 2016(43), 58–69.CrossRef Öst, L. G., Riise, E. N., Wergeland, G. J., Hansen, B., & Kvale, G. (2016). Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. Journal of Anxiety Disorders, 2016(43), 58–69.CrossRef
go back to reference Padesky, C. A. (1994). Schema change processes in cognitive therapy. Clinical Psychology and Psychotherapy, 1, 267–278.CrossRef Padesky, C. A. (1994). Schema change processes in cognitive therapy. Clinical Psychology and Psychotherapy, 1, 267–278.CrossRef
go back to reference Purdan, C., & Clark, D. A. (1993). Obsessive intrusive thoughts in nonclinical subjects: Part I Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31, 713–720.CrossRef Purdan, C., & Clark, D. A. (1993). Obsessive intrusive thoughts in nonclinical subjects: Part I Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31, 713–720.CrossRef
go back to reference Radomsky, A. S., Dugas, M. J., Alcolado, G. M., & Lavoie, S. L. (2014). When more is less: Doubt, repetition, memory, metamemory, and compulsive checking in OCD. Behaviour Research and Therapy, 59, 30–39.PubMedCrossRef Radomsky, A. S., Dugas, M. J., Alcolado, G. M., & Lavoie, S. L. (2014). When more is less: Doubt, repetition, memory, metamemory, and compulsive checking in OCD. Behaviour Research and Therapy, 59, 30–39.PubMedCrossRef
go back to reference Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40(6), 625–639.PubMedCrossRef Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40(6), 625–639.PubMedCrossRef
go back to reference Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.PubMedCrossRef Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.PubMedCrossRef
go back to reference Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–248.PubMedCrossRef Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233–248.PubMedCrossRef
go back to reference Rassin, E., & Muris, P. (2006). Abnormal and normal obsessions; a reconsideration. Behaviour Research and Therapy, 45, 1065–1070.PubMedCrossRef Rassin, E., & Muris, P. (2006). Abnormal and normal obsessions; a reconsideration. Behaviour Research and Therapy, 45, 1065–1070.PubMedCrossRef
go back to reference Rector, N. A., Richter, M. A., Katz, D., & Leybman, M. (2018). Does the addition of cognitive therapey to exposure and repsonse preventeion for obsessive compulsive disorder enhance clincial efficacy? A randomized controlled trial in a community settin. British Journal of Clinical Psychology. ahead of print. https://doi.org/10.111/bcj12188. Rector, N. A., Richter, M. A., Katz, D., & Leybman, M. (2018). Does the addition of cognitive therapey to exposure and repsonse preventeion for obsessive compulsive disorder enhance clincial efficacy? A randomized controlled trial in a community settin. British Journal of Clinical Psychology. ahead of print. https://​doi.​org/​10.​111/​bcj12188.
go back to reference Röper, G., & Rachman, S. (1976). Obsessional compulsive checking: Experimental replication and development. Behaviour Research and Therapy, 14, 23–32.CrossRef Röper, G., & Rachman, S. (1976). Obsessional compulsive checking: Experimental replication and development. Behaviour Research and Therapy, 14, 23–32.CrossRef
go back to reference Röper, G., Rachman, S., & Hodgson, R. (1973). An experiment on obsessional checking. Behaviour Research and Therapy, 11, 271–277. Röper, G., Rachman, S., & Hodgson, R. (1973). An experiment on obsessional checking. Behaviour Research and Therapy, 11, 271–277.
go back to reference Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.PubMedCrossRef Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.PubMedCrossRef
go back to reference Salkovskis, P. M. (1989). Cognitive-behavioural problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRef Salkovskis, P. M. (1989). Cognitive-behavioural problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRef
go back to reference Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29–S59.PubMedCrossRef Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29–S59.PubMedCrossRef
go back to reference Salkovskis, P. M., & Campbell, P. (1994). Thought suppression induces intrusion in naturally occurring negative intrusive thoughts. Behaviour Research and Therapy, 32, 1–8.PubMedCrossRef Salkovskis, P. M., & Campbell, P. (1994). Thought suppression induces intrusion in naturally occurring negative intrusive thoughts. Behaviour Research and Therapy, 32, 1–8.PubMedCrossRef
go back to reference Salkovskis, P. M., & Harrison, J. (1984). Abnormal and normal obsessions; A replication. Behaviour Research and Therapy, 22, 549–552.PubMedCrossRef Salkovskis, P. M., & Harrison, J. (1984). Abnormal and normal obsessions; A replication. Behaviour Research and Therapy, 22, 549–552.PubMedCrossRef
go back to reference Tolin, D. F., Worhunsky, P., & Maltby, N. (2006). Are ‘obsessive’ beliefs specific to OCD? A comparison across anxiety disorders. Behaviour Research and Therapy, 44, 469–480.PubMedCrossRef Tolin, D. F., Worhunsky, P., & Maltby, N. (2006). Are ‘obsessive’ beliefs specific to OCD? A comparison across anxiety disorders. Behaviour Research and Therapy, 44, 469–480.PubMedCrossRef
go back to reference Trindel, H., & Salkovskis, P. M. (1994). Personally relevant intrusions outside the laboratory: Long term suppression increases intrusion. Behaviour Research and Therapy, 32, 833–842.CrossRef Trindel, H., & Salkovskis, P. M. (1994). Personally relevant intrusions outside the laboratory: Long term suppression increases intrusion. Behaviour Research and Therapy, 32, 833–842.CrossRef
go back to reference van den Hout, M. A. (2010). Even checken. In A. Jansen, M. van den Hout, & H. Merckelbach (red.), Gek: Experimentele psychopathologie; over angst, verslaving, depressie en andere ellende. Houten: Bohn Stafleu van Loghum. van den Hout, M. A. (2010). Even checken. In A. Jansen, M. van den Hout, & H. Merckelbach (red.), Gek: Experimentele psychopathologie; over angst, verslaving, depressie en andere ellende. Houten: Bohn Stafleu van Loghum.
go back to reference van den Hout, M.A., & Kindt. (2003). Repeated checking causes memory distrust. Behaviour Research and Therapy, 41, 301–316.PubMedCrossRef van den Hout, M.A., & Kindt. (2003). Repeated checking causes memory distrust. Behaviour Research and Therapy, 41, 301–316.PubMedCrossRef
go back to reference van Oppen, P., & Arntz, A. (1994). Cognitive therapy for obsessive compulsive disorder. Behaviour Research and Therapy, 32, 79–87.PubMedCrossRef van Oppen, P., & Arntz, A. (1994). Cognitive therapy for obsessive compulsive disorder. Behaviour Research and Therapy, 32, 79–87.PubMedCrossRef
go back to reference van Oudheusden, L. J. B., Eikelenboom, M., van Megen, H. J. G. M., Visser, H. A. D., Schruers, K., Hendriks, G. J., et al. (2018). Chronic obsessive-compulsive disorder: Prognostic factors. Psychological Medicine, 9, 1–10. van Oudheusden, L. J. B., Eikelenboom, M., van Megen, H. J. G. M., Visser, H. A. D., Schruers, K., Hendriks, G. J., et al. (2018). Chronic obsessive-compulsive disorder: Prognostic factors. Psychological Medicine, 9, 1–10.
go back to reference Visser, H. A., van Oppen, P., van Megen, H., Eikelenboom, M., & van Balkom, A. J. L. M. (2014). Obsessive compulsive disorder: Chronic versus non-chronic symptoms. Journal of Affective Disorder, 152, 169–174.CrossRef Visser, H. A., van Oppen, P., van Megen, H., Eikelenboom, M., & van Balkom, A. J. L. M. (2014). Obsessive compulsive disorder: Chronic versus non-chronic symptoms. Journal of Affective Disorder, 152, 169–174.CrossRef
go back to reference Wegner, D. M. (1989). White bears and other unwanted thoughts: Suppression, obsession and the psychology of mental control. New York: Viking. Wegner, D. M. (1989). White bears and other unwanted thoughts: Suppression, obsession and the psychology of mental control. New York: Viking.
go back to reference Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester: Wiley. Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester: Wiley.
go back to reference Wu, Y., Lang, Z., & Zhang, H. (2016). Efficacy of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder: A meta-analysis. Medical Science Monitor, 22, 1646–1653.PubMedPubMedCentralCrossRef Wu, Y., Lang, Z., & Zhang, H. (2016). Efficacy of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder: A meta-analysis. Medical Science Monitor, 22, 1646–1653.PubMedPubMedCentralCrossRef
Metagegevens
Titel
Cognitieve therapie bij dwangstoornis
Auteurs
prof. dr. Patricia van Oppen
dr. Henny Visser
Copyright
2019
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2021-9_8