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Cognitieve therapie voor demoralisatie bij schizofrenie
Samenvatting
In dit artikel wordt een behandelprotocol geschetst om demoralisatie bij patiënten met schizofrenie te behandelen. De behandeling wordt geplaatst in de context van een cognitief model van demoralisatie. De nadruk van dit model ligt op overdreven negatieve verwachtingen omtrent de eigen capaciteiten en sociale uitstoting. Deze verwachtingen vinden hun basis vermoedelijk in de geleden verliezen en cognitieve achteruitgang die patiënten hebben ondergaan, maar zijn desalniettemin vaak onrealistisch en werken vermijding en inactiviteit in de hand. Voor de assessment wordt het demoralisatie-interview gebruikt. Daarna bestaat de behandeling uit cognitief gedragstherapeutische interventies om de cognities waar mogelijk te corrigeren en vermijdingsgedrag op te heffen. Het doel van de therapie is niet om patiënten te herstellen tot hun oude niveau van functioneren, maar om ze te helpen bij het doorbreken van isolatie en inactiviteit door hun persoonlijke en situationele bronnen te mobiliseren en een zinvolle relatie te koesteren en doen groeien met de wereld om hen heen. Er worden verscheidene casusssen gebruikt om de theorie toe te lichten.
Summary
Cognitive behavioral therapy for demoralization in patients with schizophrenia
In this article, a therapy is outlined for treating demoralization in patients with schizophrenia. The therapy is placed within the context of a cognitive model of demoralization, and focuses on patients' negative expectations concerning their capabilities and social exclusion. These expectations are presumably based on the losses that they have suffered and on cognitive impairments, but are nonetheless often unrealistic and lead to avoidance and inactivity. For assessment, a specialized demoralization interview was developed. The therapy itself consists of cognitive-behavioral strategies to correct patients' dysfunctional thought patterns and to gradually expose patients to situations they have been avoiding. The goal of the therapy is not for patients to regain their old level of functioning, but rather to help them overcome isolation and inactivity, by mobilising their personal and contextual resources and by nourishing a meaningful bond with their environment. Various case studies are used to demonstrate how this may work.
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