
dilectical behaviour therapy

vyakthithva vaikalyangalum paraspara vairudhyangalum chikilsikkaanulla sramangalil ninnu aarambhicha oru thelivu adisthaanamaakkiyulla psychotherapy dilectical behaviour therapy (dbt). maanasika vaikalyangalkkum aathmahathyaa ashayangalkkum chikilsikkunnathinum svayam dosham, laharivasthukkalude upayogam thudangiya perumatta reethikal mattunnathinum dbt upayogapradamaakumennu thelivukal soochippikkunnu. theraappistum klayantum sveekaaryathayodum maattathe adisthaanamaakkiyulla thanthrangalodum koodi pravartthikkukayum aathyanthikamayi avaye santhulithamaakkukayum samanvayippikkukayum cheiyunna oru prakriyayayi dbt parinamichu-sidhaanthathinteyum virudhathayudeyum daarshanika bhasha prakriyayumaayi thaarathamyappeduthumbol, thudarnnu synthesis.
eee sameepanam vikasippichath marsha emm aanu. washington sarvakalaashaalayile manahshaasthra gaveshakayaanu linehan. ethirvashangalude samanvayamo samyojanamo" ennaanu avar vairudhyathe nirvachikkunnath. prathikaranaavasthakalilekku nayikkunna trigarukalekkurichu padikkunnathiloodeyum sambhavangal, chinthakal, vikarangal, perumattangal ennivayude kramatthil prayogikkenda eathu copping kazhivukal upayogikkanamennu vilayiruthaan sahaayikkunnathiloodeyum aalukalkk avarude vaikaarikavum vaijnjaanikavumaaya niyanthranam vardhippikkaan sahaayikkunnathinaan dbt roopakalppana cheythirikkunnathu. marsha emm. thante swantham poraattangalum thaan borderline pezhsanaalitti desorder anubavikkunnu enna vishwaasavum leinhan pinneedu pothujanangalodu velippeduthi. aaa samayat aval athu thiricharinjillenkilum, dbt srishtikkumbol, oru rogiyenna nilayil thanikk svayam aavasyamaanennu thonnunnathinte swathasidhamaaya bodhatthil ninnaan aval therapy vikasippichukondirunna.
1970 kalude avasaanathil staanderd cognitive behavioural therapy (cbt) protocolukal deerghakaalamaayi aathmahathya cheiyunna klayantukalkku prayogikkunnathinulla parajayappetta shramangalude oru parambarayil ninnaan dbt valarnnathu. mattu avasthakal chikilsikkunnathil athinte falapraapthiyekkurichulla gaveshanam falapradamaanu; vishaadam, mayakkumarunnu, madyapaana prasnangal, poost trometic stress desorder (ptsd), trometic braine parikkukal (tbi), amithabhakshana desorder, maanasika vaikalyangal ennivayulla aalukale chikilsikkaan doctormar dbt upayogikkunnu. svayam parikk ulppedeyulla spectrum maanasika vaikalyangalumayi bandhapetta lakshanangalum perumattangalum ulla rogikale dbt sahaayichekkaamenn gaveshanangal soochippikkunnu. laingika durupayogathe athijeevichavarumaayum raasa aashrithathvathodum athinte falaprapti eee kruthi soochippikkunnu.
vikaara niyanthranathinum yaadhaarthya parishodhanaykkumulla staanderd cognitive-behavioural teknikkukale dbt samyojippikkunnu, vishamam sahishnutha, sveekaaryatha, dhyana parisheelanatthil ninnu pradhaanamaayum uruthirinja bodhapoorvamaaya avabodham ennee aashayangalumayi. maanasikarogatthinte jaiva saamoohika sidhaanthathe adisthaanamaakkiyulla dbt, borderline pezhsanaalitti desorder (bpd) chikilsikkunnathil pothuve phalapradamaanennu pareekshanaathmakamaayi theliyikkapetta aadyathe chikilsayaanu. dbtyude aadyathe kramarahithamaya klinikkal trial pathivupole chikilsayumaayi thaarathamyappeduthumbol aathmahathyaa aamgyangal, maanasika ashupathriyil praveshippikkal, chikitsa upekshikkal ennivayude nirakk kuranju. bpd ullavaril dbt mithamaaya phalangalil athiyathaayi oru mettaa vishakalanam kandethi.
avalokanam.
sammarddathe neridaan rogikale sahaayikkunnathin dbt cbt sweekarikkunnathinaal dbt chilappol dbtyude bhaagamaayi kanakkakkunnu.
maanasika prashnangalude chikilsayil oru ethiraaliyekkaal sweekarikkunna oru sakhyakakshiyayi rogi theraappisttine veekshikkaan dbt sramikkunnu eee samayathe pala chikilsakalum eee reethikal "kognishanukalum perumattangalum maattunnathil shradha kendreekaricha reethi kaaranam" vimarshikkappedukayum thettidharikkappedukayum asaadhuvaayi "anubhavappedukayum cheiyunnu."athanusarichu, theraappist eathu samayathum klayantinte vikarangal amgeekarikkaanum saadhookarikkaanum lakshyamidunnu, ennirunnaalum, chila vikaarangalum perumattangalum anuchithamaanennu klayantine ariyikkukayum avarkk mikacha badalukal kaanikkukayum cheiyunnu. prathyekichum, aaa perumaattatthinte pravartthanam thirichariyukayum dbt copping kazhivukaliloode aaa pravartthanam surakshithamaayi nedukayum cheythukondu dbt svayam-dosham cheiyunnathinum aathmahathya cheiyunnathinumulla shramangale lakshyamidunnu. jeevikkaan yogyamaaya jeevitam" neduka enna aathyanthika lakshyathode klayant puthiya kazhivukal nedunnathilum avarude perumattangal maattunnathilum dbt shradha kendreekarikkunnu.
dbtyude biosocial sidhaanthamaaya bpdyil, klayantukalkku vaikaarika niyanthranakkuravin oru jaiva pravanathayundu, avarude saamoohika anthareeksham thettaaya perumaattatthe saadhookarikkunnu.
chila klinikkal krameekaranangalil chikitsa lakshyangal abhisambodhana cheyyaan dbt naipunya pariseelanam maathram upayogikkunnu, koodaathe dbtyil kaanunna vikaara niyanthranatthinte vishalamaaya lakshyam puthiya krameekaranangalil upayogikkaan anuvadichu, udaaharanathinu, rakshaakarthruthvathe pinthunaykkunnu. dbt oru oonlain parithasthithiyumaayi poruthappeduthunnathinnu valare kurachu padanangal maathrame nadannittulloovenkilum, klayantukalkku parambaraagatha modumaayi thaarathamyappeduthaavunna mechappeduthalukalode oonlainil hajar mechappettathaayi oru avalokanam soochippikkunnu.
naalu moduleukal.
bodhavalkaranam.
dbtyude ellah gadakangalkkum pinnile pradhana aashayangalilonnaan mindlifness. dbtyil padippikkunna mattu kazhivukalude aditharayaayi ithu kanakkaakkappedunnu, kaaranam ithu vyakthikalkk avarude sheelangale velluvilikkumbozho aswasthappeduthunna saahacharyangalilekku svayam thurannukaattumbozho anubhavappedunna sakthamaaya vikarangal sweekarikkaanum sahikkanum sahayikkunnu.
dbt yill padippikkunna pathippil mathaparamo adhibhouthikaparamo aaya ashayangalonnum ulppedunnillengilum, mindfulness enna ashayavum athu padippikkaan upayogikkunna dhyana vyaayaamangalum parambaraagatha chinta mathaparamaya achaarangalil ninnaan uruthirinjathu. dibidikkullil, varthamaana nimishatthilekku, nyaayabodhamillathe, shradha cheluthaanulla kazhivaanu; nimishathil jeevikkunnathinekkurichu, oraalude vikaarangalum indriyangalum poornnamaayum anubhavikkunnathinekkur, pakshe kaazhchappaadode. sparsanam, manam, kazhcha, ruchi, shabdam ennee anchu indriyangaliloode aalukale avarude paristhithiyekkurichu kooduthal bodhavaanmaaraakkaanum mindlifness pariseelikkaan uddeshikkaam. bodhavalkaranam sveekaaryathayude thathwathe valareyadhikam aasrayikkunnu, chilappol ithine "samoolamaaya sveekaaryatha" ennu vilikkunnu. theerumaanangalonnumillathe saahacharyangale kaananum saahacharyangalum avayodoppamulla vikaarangalum sweekarikkaanumulla rogiyude kazhivine aasrayichirikkunnu sveekaaryatha kazhivukal. ithu mothatthil budhimuttukal kuraykkunnu, ithu aswasthathayum rogalakshanangalum kuraykkunnathinu kaaranamakum.
sweekaaryathayum maattavum.
dbtyude aadya kurachu sessionukal sweekaaryathayudeyum maattathinteyum vairudhyathe parichayappedutthunnu. rogi aadyam therapy enna aashayathil sukhamaayirikkanam; rogiyum theraappistum vishwasaneeyamaaya bandham sthaapichukazhinjaal, dbt saankethikavidyakal abhivridhippedum. patana sveekaaryathayude oru pradhana bhagam aadyam samoolamaaya sveekaaryatha enna ashayam manassilakkuka ennathaanu samoolamaaya sveekaaryatha oraal vidhinyaayamillathe positteev, negatteevu saahacharyangale abhimukeekarikkanam enna ashayathe ulkkollunnu. samoolamaaya sveekaaryatha enna ashayathe aashrayichirikkunna bodhavalkkaranavum vaikaarika niyanthrana kazhivukalum sveekaaryathayil ulppedunnu. eee kazhivukalaanu mattu chikilsakalil ninnu dbt prathyekamaayi verthirikkunnathu.
palappozhum, oru rogikk sveekaaryatha enna ashayam parichithamaayikkazhinjaal, avar athine maattathode anugamikkum. dbtic anchu prathyeka maattangalund, athu theraappist rogiyumaayi avalokanam cheyyum munkootty sangalppikkuka, chinthikkuka, thayyaaredukkuka, pravartthikkuka, paripaalikkuka. rogiyude prashnathekkurichu poornnamaayum ariyaatha aadya gattamaanu pree-condumplation. randaam ghattathil, dhyaanathil, rogi avarude rogathinte yaadhaarthyam manassilaakkunnu ithu oru pravrithiyalla, marichu oru thricharivu aanu. moonnaam ghattam, thayyaareduppu, rogi nadapadiyedukkaanum munnott pookaanum thayyaaredukkaanum saadhyathayund. ithu theraappisttukale gaveshanam cheiyukayo bandhappedukayo cheiyunnathu pole lalithamayirikkum. oduvil, naalam ghattathil, rogi nadapadiyedukkukayum chikitsa sweekarikkukayum cheiyunnu. attakuttappanikalude avasana ghattathil, rogiyude maattam aavarthanam thadayunnathinu rogi shakthippeduthanam. sweekaaryathayum maattavum manassilakkiya sesham, oru rogikk bodhavalkarana saankethikavidyakalilekku poornnamaayum munneraan kazhiyum.
yukthisahamaya manassinteyum vaikaarika manassinteyum samanvayamaaya "njaanamulla manass" nedunnathinu klayantine kooduthal aduppikkunnathinu dbtyil aarr mindfulness kazhivukal upayogikkunnu moonnu "enthaanu" kazhivukal (nireekshikkuka, vivarikkuka, pankedukkuka), moonnu "engane" kazhivukal (vidhinyaayamillathe, ekamanassode, phalapradamaayi).
durita sahishnutha.
maanasikaarogya chikilsaykkulla nilavile pala sameepanangalum priyappetta oraalude maranam, jolie nashtappedal, gurutharamaaya asukham, theevravaada akramanangal, mattu aaghaathakaramaaya sambhavangal enniva kaikaaryam cheiyunnathupolulla durithakaramaaya sambhavangalilum saahacharyangalilum maattam varuthunnathilaanu shradha kendreekarikkunnathu. kashtappaadukal sweekarikkunnathilum ardham kandethunnathilum sahikkunnathilum avar kaaryamaaya shradha cheluthiyittilla. vyakthi kendreekrithavum maanasikavaividyaparavum manashaasthraparavum gestaalt allengil aakhyaana chikilsakalum mathaparavum aathmeeyavumaaya samoohangalum nethaakkalum chernnaanu eee dauthyam saadhaaranayaayi kaikaaryam cheythirikkunnathu. dilectical behaviour therapy vedana naipunyathode thangaan padikkunnathinu oonnal nalkunnu. doshakaramaayava maattisthaapikkaan uddeshichulla aarogyakaramaya perumattangal (shradha vyathichalippikkal, nimisham mechappeduthal, svayam aashvaasam, enthaanu sweekarikkunnathu ennu pariseelikkal) eee module roopappeduthunnu.
dbt mindfulness kazhivukalil ninnulla swaabhaavika vikasanamaan vishamam sahishnutha kazhivukal. avarkk svayam, nilavile sahacharyam, moolyanirnnayamillaathum vidhinyaayamillaathathumaaya reethiyil sweekarikkaanulla kazhivumayi bandhappettirikkunnu. ithu vidhinyaayaparamallatha nilapaadaayathinaal, ithu amgeekaaramo raaji nischayamo allah ennaanu ithinartham. prathikoola saahacharyangalum avayude swaadheenavum manasilakkaan praaptharaakuka ennathaanu lakshyam, athil ninnu amithamaayi olichirikkukayo olichirikkukayo cheiyunnathinupakaram. athirthi vyakthithva vaikalyathinte bhagamaaya theevravum nirashaajanakavum palappozhum vinashakaravumaaya vaikaarika prathikaranangalil veezhunnathinupakaram, engane nadapadiyedukkanam, engane edukkanam ennathinekkurichu vivekapoornamaaya theerumaanangal edukkaan ithu vyakthikale anuvadikkunnu.
vikaara niyanthranam.
borderline pezhsanaalitti disorder aathmahathya cheiyunna vyakthikalum palappozhum vaikaarikamaayi theevravum asthiravumaanu. avarkk deshyamo theevramaaya niraashayo vishaadamo uthkandayo undakam. eee upabhokthaakkalkk avarude vikarangal niyantrikkaan padikkunnathinulla sahaayathil ninnu prayojanam labhikkumenn ithu soochippikkunnu. vikaara niyanthranathinulla dilectical behaviour therapy kazhivukalil iva ulppedunnu
vaikaarika niyanthrana kazhivukal prasnakaramaaya anubhavangalodulla vyavasthaapitha prathikaranamaanu theevramaaya vikarangal, vyavasthaapitha uthejanam, athinaal rogiyude vyavasthaapitha prathikaranatthil maattam varuthaan avaa aavasyamaanu enna sidhaanthathe adisthaanamaakkiyullathaanu. eee kazhivukale naalu moduleukalaayi tharamthirikkaam vikarangal manasilakkukayum peridukayum cheyyuka, anaavashya vikarangal maattuka, durbalata kuraykkuka, angeyattatthe saahacharyangal kaikaaryam cheyyuka
paraspara falaprapti.
dbtyil shradha kendreekarikkunna moonnu paraspara naipunyangalil aathmaabhimaanam, mattullavarodu "shradha, thalpparyam, moolyanirnnayam, bahumanam", dridanishchayam enniva ulppedunnu. aarogyakaramaya bandhangalil ulppedunna vairudhyathil mattullavarude aavasyangalum svayam aavasyangalum santhulithamaakkukayum oraalude aathmaabhimaanam nilanirthukayum cheiyunnu.
upakaranangal.
prasakthamaaya vikaarangalum perumattangalum tracuchaian prathyeka formet cheytha dayari cardukal upayogikkaam. dayari cardukal divasena poorippikkumbozhaanu avaa ettavum upayogapradamaakunnathu. oro therapy sessionteyum ajandaye nayikkunna chikitsa mungananakal kandethaan dayari card upayogikkunnu. enthaanu mechappettathenno moshamaayenno athepadi thudarnnathenno arian klayantinum therapistinum dayari card upayogikkaam.
shringhala vishakalanam.
perumaattatthinte pravarthanaparamaaya vishakalanathinte oru roopamaanu cheyin analysis, ennaal perumatta shringhala roopappeduthunna thudarchayaaya sambhavangalil kooduthal shradha kendreekarikkunnu. ithinu perumatta manahshaasthrathil sakthamaaya verukalundu, prathyekichu chaininginte prayogaathmaka perumatta vishakalana ashayam. valarunna gaveshana samgham onniladhikam janasamkhyakalulla perumatta shringhala vishakalanathinte upayogathe pinthunaykkunnu.
falaprapti.
borderline pezhsanaalitti desorder.
borderline pezhsanaalitti desorder chikilsaykkaayi ettavum kooduthal padicha theraappiyaan dbt, koodaathe borderline pezhsanaalitti desorder chikilsikkaan dbt sahaayikkumenn nigamanam cheyyaan mathiyaya padanangal nadannittundu. dbt chikilsaykku sesham bpd ulla vyakthikalil neurobiological mattangal undennu niravadhi padanangal kandethiyittundu.
vishaadam.
duke sarvakalaashaalayile oru pailat patanam vishaadathe aantidiprasant marunnukal vazhiyulla chikitsa aantidiprasants vazhiyulla chikilsayumaayum dilectical behaviour therappiyumaayum thaarathamyam cheythu. 60 vayassinu mukalilulla 34 theevra vishaadabaadhitharaaya vyakthikal 28 aazhchathekku chikilsichu. chikitsa kazhinju aarumaasathinusesham, grouppukal thammilulla rogamochana nirakkil sthithivivarakkanakkukali ganyamaaya vyathyaasangal sradhikkappettu, kooduthal sathamaanam rogikalum aantidiprasantukalum dilectical behaviour therapy upayogichu chikilsichu.
complexes poost trometic stress desorder (sii. pii. tii. ezz. dii).
sankeernamaaya aaghaatham allengil rakshappedaanulla saadhyatha kurravulla neenda aaghaathathinte anubhavam oru vyakthiyil sankeernamaaya poost trometic stress desorder (sii. pii. tii. ezz. dii) vikasikkunnathilekku nayichekkaam. manahshaasthra samoohathe vibhajikkunna oru aashayamaanu sii. pii. tii. ezz. dii. american cycatric association (apa) ithu dsm-5 (maanasika vaikalyangalude diagnostic, stattistikkal maanuval, maanasika rogam nirnnayikkaanum chikilsikkaanum charcha cheyyaanum daathaakkal upayogikkunna maanuval) ll amgeekarikkunnilla, ennirunnaalum chila pariseelakar sii. pii. tii. ezz. dii poost trometic stress disorderil (ptsd) ninnu vyathyasthamaanennu vaadikkunnu.
sii. pii. tii. ezz. dii. pii. tii. ezz. dii. kku samaanamaan, kaaranam athinte rogalakshanashasthram vyaapakamaanu, koodaathe vaijnjaanikavum vaikaarikavum jaivaparavumaya mekhalakal ulppedunnu. kuttikkaalatthe vyakthiparamaaya aaghaatham allengil vittumaaraatha balyakaala sammarddam ennivayil ninnaan ithu uthbhavikkunnathenn vishwasikkappedunnathil sii. pii. tii. ezz. dii. pii. tii. ezz. diyil ninnu vyathyasthamaan, koodaathe ettavum saadhaaranamaaya mungaamikal laingika aaghaathangalaanu. nilavil sii. pii. tii. ezz. diyude vyaapanam 0.5 shathamaanamaanennum pii. tii. ezz. diyude vyaapanam 1.5 shathamaanamaanennum kanakkaakkappedunnu. sii. pii. tii. ezz. dick niravadhi nirvachanangal nilavilundu. lokaarogya samghadana (aarr), internaashanal sosaitti phoor trometic stress stadees (aii. ezz. tii. ezz), vyakthigatha klinishyanmaarum gaveshakarum ennivar vyathyastha pathippukal sambhavana cheiyunnu.
mikka nirvachanangalum mattu niravadhi domainukal cherkkunnathinoppam pii. tii. ezz. diyude maanadandatthe chuttippattiyaan. sii. pii. tii. dii. yeei apa thirichariyaan kazhinjillengilum, rogangalude anthaaraashtra vargeekaranathinte (icd-11) pathinonnam pathippil eee syndrome thiricharinjathu aaraan. oraalkk sammarddam anubhavappedukayo kudungikkidakkukayo cheiyunna onno athiladhikamo sambhavangalkk sheshamulla oru thakaraaraan sii. pii. tii. dii. ennu nirvachikkunna vyakthi, kuranja aathmaabhimaanam, vyakthiparamaaya kurravukal, swaadheena niyanthranatthile kurravukal enniva ithinte savisheshathakalaan. mattu lakshanangalkoppam, eee aaghaatha niyanthranatthile kurravukal sii. pii. tii. dii. yeei chilappol borderline pezhsanaalitti disorderumaayi (bpd) thaarathamyam cheiyunnathinu oru kaaranamaan.
sii. pii. tii. ezz. diyum borderline pezhsanaalitti disorder thammilulla samanathakal.
aniyanthrithamaaya avasthaye baadikkunnathinu purame, sii. pii. tii. ezz. dii ulla rogikalkku pilarpp, maanasikaavasthayile vyathiyanangal, upekshikkappedumenna bhayam ennivayum prakadippikkaamennu cases padanangal velippeduthunnu. borderline pezhsanaalitti desorder ulla rogikaleppole, sii. pii. tii. ezz. dii ulla rogikalkku idaykkide koodaathe/allengil avarude vikasanathinte thudakkathil thanne aaghaatham sambhavikkukayum sariyaaya prathirodha samvidaanangal orikkalum padikkukayum cheythilla. eee vyakthikal ozhivakkal, padaarthangal, verthirikkal, mattu thettaaya perumattangal enniva kaikaaryam cheyyaan upayogichekkaam. athinaal, sii. pii. tii. ezz. diyude chikilsayil vijayakaramaya perumattangal sthirappeduthukayum padippikkukayum cheyyuka, niyanthranathe badhikkuka, paraspara bandhangal srishtikkukayum paripalikkukayum cheyyuka enniva ulppedunnu. 
rogalakshanangal pankidunnathinu purame, sii. pii. tii. dii. ykkum bpd. ykkum neurophysiological samanathakal pankidaan kazhiyum, udaaharanathinu, amigdalayude (vaikaarika oormma) asaadhaarana alavu, hippocampus (oormma), antrior singulate courtex (vikaaram), oorbittal prefrondal courtex (vyakthithvam). sii. pii. tii. ezz. diyum bii. pii. diyum thammilulla mattoru savisheshatha verpiriyunnathinulla saadhyathayaanu. sii. pii. tii. siyude mukhamudrayaayi vighadanathinte vishwaasyatha nirnnayikkaan kooduthal gaveshanam aavasyamaanu, ennirunnaalum ithu oru saadhyamaaya lakshanamaan. rund vaikalyangaludeyum pankitta rogalakshanavum shaareerika paraspara bandhavum kaaranam, oru vaikalyathin phalapradamaaya oru chikitsa matte rogathinum phalapradamaakumennu manasshaasthranjar anumanikkaan thudangi.
sii. pii. tii. ezz. diyude chikilsayaayi dbt.
perumatta maattathodulla sameepanamaayi dbt sweekarikkunnathum lakshyabodham upayogikkunnathum shaaktheekaranathin sahayikkukayum chikitsa prakriyayil vyakthikale earppeduthukayum cheyyum. bhaaviyilum maattatthilum shradha kendreekarikkunnathu oru vyakthiye avarude aaghaathathinte charithratthil amithamaayi akappedunnathil ninnu thadayaan sahayikkum. eee roganirnayathil onniladhikam aaghaathangal saadhaaranamaayathinaal ithu prathyekichu sii. pii. tii. ezz. diyude apakadasaadhyathayaan. saadhaaranayaayi, paricharana daathaakkal chikilsayude mattu vashangalilekku neengunnathin munbu oru upabhokthaavinte aathmahathya abhisambodhana cheiyunnu. oru vyakthiye aathmahathya chinthakal anubhavikkan ptsdk kazhiyumennathinaal, aathmahathya sthirappeduthunnathinum mattu chikitsa reethikalil sahayikkunnathinumulla oru oopshanaanu dbt.
sii. pii. tii. ezz. dii chikilsikkaan dbt upayogikkaamenkilum, ithu saadhaarana ptsd chikilsakalekkaal phalapradamallennu chila vimarshakar vaadikkunnu. koodaathe, dbt svayam parukketta perumattangal (murikkal allengil kathal polullava) kuraykkukayum paraspara pravartthanam vardhippikkukayum cheiyunnuvennum ennaal avesham, cognitive skeemakal (aavarthichulla, negatteevu chinthakal), kuttabodham, lajja thudangiya vikarangal thudangiya pradhana sii. pii. tii. dii lakshanangale avaganikkunnuvennum eee vaadam abhipraayappedunnu. aaghaathakaramaaya oormmakalil shradha kendreekarikkunnathinum, veendedukkalinte oru multiface model upayogichu, saadhaarana pii. tii. ezz. dii chikilsayil ninnu vyathyasthamaaya chikitsa sii. pii. tii. ezz. dick aavasyamaanennu aii. ezz. tii. ezz report cheiyunnu. suraksha, durita sahishnutha, saamoohika bandhangal enniva sthaapikkuka ennivayaanu shupaarsha cheyyappetta multiface model.
dbtic saadhaaranayaayi eee maarganirddeshangalumaayi (mindfulness, distress tolerance, imphakt regulation, interpezhsanal skills) yojikkunna naalu moduleukal ullathinaal ithu oru chikitsa oopshanaanu. dbtyude mattu vimarsanangal therapy falapradamaakaan aavashyamaaya samayathekkurichu charcha cheiyunnu. dbt aagrahikkunna vyakthikalkk aavashyamaaya vyakthigatha, group sessionukalil earppedaan kazhinjekkilla, allengil avarude insurance ellah sessionukalum ulkkollanamennilla.
leinhan saha-rachicha oru padanatthil bpdic autpeshyant paricharanam labhikkuna sthreekalil kazhinja varsham aathmahathyaykk shramichavaril 56 sathamaanam perr ptsdude maanadandangal paalikkunnundennu kandethi. borderline pezhsanaalitti desorder swabhaavasavisheshathakalum aaghaathavum thammilulla parasparabandham kaaranam, chila krameekaranangal aaghaathakaramaaya lakshanangalkulla chikilsayaayi dbt upayogikkaan thudangi. chila daathaakkal deerghakaala exposure therapy (pe) (oru cycotherapy sessionile aaghaathathekkurichulla vishadamaaya vivaranam aavarthikkuka) allengil cognitive prosessing therapy (sii. pii. tii) (aaghaathakaramaaya oormmakalumaayi bandhapetta vaijnjaanika skeemakale abhisambodhana cheiyunna cycotherapy) polulla mattu pii. tii. ezz. dii edapedalukalumaayi dbt samyojippikkaan thiranjedukkunnu.
udaaharanathinu, pe, dbt enniva samyojippikkunna oru rejimenil mindfulness kazhivukalum distress tolerance kazhivukalum padippikkukayum pinneedu pe nadappilaakkukayum cheyyum. oru aaghaatham undakunnathinekkurichum athu avarude jeevithathiludaneelam avare engane baadhikkumenn thudarnnum amgeekarikkunnathinekkuri eee rogamulla vyakthiye padippikkum. ithupolulla klinikkal pareekshanangalil pankedutthavar rogalakshanangalil kuravu kaanichu, 12 aazhchathe pareekshanatthiludaneelam svayam parikkukal allengil aathmahathyaaparamaaya perumattangalonnum report cheyyapettilla.
aaghaathathinulla chikilsayaayi dbt upayogikkunnathine pinthunaykkunna mattoru vaadam vaikaarika niyanthranam, vishamam thudangiya ptsd lakshanangale aasrayichirikkunnu. exposure therapy polulla chila pii. tii. ezz. dii chikilsakal vishaadaroga sahishnutayum koodaathe/allengil vikaara niyanthranavum kurravulla vyakthikalkk anuyojyamallayirikkaam. oru vyakthiyude uyarnna vaikaarika samvedanakshamathayum paaristhithika gadakangalum (vikaarangalude asaadhuvaayikkal, thudarchayaaya durupayogam/aaghaatham), roominett cheyyaanulla pravanatha (oru negatteevu sambhavathekkurichu aavarthichu chinthikkuka, phalam engane maaramaayirunnu) enniva chernnaanu vaikaarika aniyanthrithamaaya vaikarikaavastha undaakunnathenn biosocial sidhaantham abhipraayappedunnu.
eee savisheshathakalulla oru vyakthi thettaaya poruthappedutthal perumattangal upayogikkaan saadhyathayund. eee sandarbhangalil dbt uchithamayirikkum, kaaranam ithu uchithamaaya prathirodha kazhivukal padippikkukayum vyakthikale oru paridhivare svayamparyaapthatha vikasippikkaan anuvadikkukayum cheiyunnu. dbtyude aadya moonnu moduleukal vyakthiyil vishamam sahishnutayum vikaara niyanthrana kazhivukalum vardhippikkukayum nuzhanjukayattam, aathmaabhimaanam, paraspara bandhangal thudangiya lakshanangalil pravartthikkaan vazhiyorukkukayum cheiyunnu.
chikilsikkappedunna janasamkhyaye adisthaanamaakki dbt palappozhum parishkarichittundu ennathaanu sradheyamaayathu. udaaharanathinu, muthirnna janasamkhyayil, exposure vyaayamangal ulppeduthunnathinum aaghaathakaramaaya mastishka parikkukalude (tbi) saannidhyam ulkkollunnathinum insurance pariraksha (athaayath.iii. hrasvamaaya chikitsa). comorbid bpd ulla aalukalkk "suraksha sthaapikkunna" ghattathil kooduthal samayam chelavazhikkendivannekkam. kaumaarapraayakkaaril, dbtyude naipunya pariseelana vasham vikaara niyanthranatthilum vikaarathe uchithamayi prakadippikkaanulla kazhivilum ganyamaaya purogathi kaivarichu. comorbid padaarthangalude upayogamulla janasamkhyayil, oro kesilum adisthaanathil poruthappedutthalukal nadatthaam.
udaaharanathinu, oru daataav prachodanaathmaka abhimukhathinte gadakangal (perumatta maattathinu prachodanam nalkaan shaaktheekaranam upayogikkunna cycotherapy) ulppeduthaan aagrahichekkaam. mayakkumarunnu upayogathinte alavum pariganikkanam. chila vyakthikale sambandhichidatholam, mayakkumarunnu upayogam maathramaan avarkariyaavunna eaka perumaattam, athinaal marunnu kuraykkunnathinu lakshyamidunnathinu munbu daataav naipunya pariseelanam nadappilakkaan shramichekkaam. vipareethamaayi, oru upabhokthaavinte laharivasthukkalude upayogam hajarnilayilo mattu chikitsa palicalilo edapedunnathaayirikkaam, koodaathe aaghaathathinu dbt nadappilaakkunnathinu munbu daataav laharivasthukkalude upayogam abhisambodhana cheyyaan theerumaanichekkaam.