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De dwangstoornis bij kinderen en jongeren, verklaringsmodellen en behandeling: een overzicht van nieuwe ontwikkelingen

Obsessive compulsive disorder in children and adolescents: theoretical models and treatment. Overview of recent developments

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Kind & Adolescent

Samenvatting

Inleiding

Hoewel de symptomen van een dwangstoornis duidelijk zijn, is het niet bekend wat het essentiële probleem ervan is. Kennis hierover kan consequenties hebben voor het behandelbeleid.

Methode

Twee psychologische verklaringsmodellen en recent onderzoek naar behandeleffectiviteit worden besproken.

Resultaten

Het cognitieve verklaringsmodel is niet aangetoond juist, maar heeft een invloedrijke vorm van behandeling gegenereerd (cognitieve therapie). Het model dat gedrag (met name herhalen) als het centrale probleem ziet, is experimenteel aangetoond. Op grond van dit model is de belangrijkste behandelstrategie exposure en responspreventie. Uit een recente meta-analyse blijkt dat cognitieve gedragstherapie (CGT) en de combinatie van CGT met medicatie effectieve behandelvormen zijn (grote effect size hebben). Als CGT wordt uitgevoerd door gespecialiseerde behandelaars is er geen verschil in effect tussen CGT en CGT gecombineerd met medicatie. Cognitive Bias Modification (CBM) en korte intensieve therapie zijn nieuwe vormen van behandeling.

Conclusie

Onderzoek naar verklaringsmodellen voor de dwangstoornis is van belang voor het verbeteren van de behandeling. CGT is effectief maar zou uitgevoerd moeten worden door gespecialiseerde behandelaars. Dat het combineren van CGT met medicatie het effect van CGT vergroot is niet aangetoond. Ouders betrekken bij de behandeling is essentieel.

Abstract

Objective

Although the symptomatology of obsessive compulsive disorders is clear, the essential problem is not. Understanding this can have consequences for treatment.

Method

Two psychological models are discussed as well as recent research into effectiveness of treatment.

Results

The cognitive model of OCD has not been conclusively established, but it has led to an influential form of treatment (cognitive therapy). The model, in which behaviour (repetition) is the central problem, has been experimentally proved. Based on this model, exposure and response prevention are key to the treatment strategy. A recent meta-analysis has shown that cognitive behavioural therapy (CBT) and the combination of CBT with medication can have large effects. Cognitive Bias Modification (CBM) and Intensive Therapy are new treatment modalities.

Conclusion

Research into models of OCD is important for improving treatment. CBT is effective, but should be given by specialists. Whether the combination of CBT and medication is more effective than CBT has not been established. Parents should be involved in the treatment.

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Authors and Affiliations

  1. Amsterdam, Nederland

    Else de Haan,  Lidewij H. Wolters &  Elske Salemink

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  1. Else de Haan
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  2. Lidewij H. Wolters
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  3. Elske Salemink
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Correspondence to Else de Haan.

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de Haan, E., Wolters, L. & Salemink, E. De dwangstoornis bij kinderen en jongeren, verklaringsmodellen en behandeling: een overzicht van nieuwe ontwikkelingen. Kind Adolesc 36, 248–261 (2015). https://doi.org/10.1007/s12453-015-0100-5

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