{"id":3706,"date":"2024-09-30T11:57:26","date_gmt":"2024-09-30T08:57:26","guid":{"rendered":"https:\/\/www.hvtd.org\/?p=3706"},"modified":"2024-09-30T11:57:26","modified_gmt":"2024-09-30T08:57:26","slug":"akut-stres-ve-travma-sonrasi-stres-bozuklugu","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=3706","title":{"rendered":"AKUT STRES VE TRAVMA SONRASI STRES BOZUKLU\u011eU"},"content":{"rendered":"

Yazar : Prof. Dr. Muzaffer \u00c7eting\u00fc\u00e7<\/p>\n

Yay\u0131nlanma tarihi : 9 Ocak 2017<\/p>\n

https:\/\/www.airkule.com\/yazar\/AKUT-STRES-VE-TRAVMA-SONRASI-STRES-BOZUKLUGU\/1161\/<\/a><\/p>\n

G\u00fcnl\u00fck rutin ya\u015fam olaylar\u0131n\u0131n \u00e7ok \u00fcst\u00fcnde s\u0131k\u0131nt\u0131 ve korku yaratan travmatik olaylar (kendine, yak\u0131nlar\u0131na veya ba\u015fkalar\u0131na y\u00f6nelik tehdit, \u015fiddet, tecav\u00fcz, \u00f6ld\u00fcrme, yakma, y\u0131kma, kaza, do\u011fal afet, vs.) herkeste \u2018akut stres\u2019 denilen tepkiler yarat\u0131r. \u00d6l\u00fcmle y\u00fcz y\u00fcze gelme veya s\u0131ra d\u0131\u015f\u0131 korkutucu, anormal ya\u015fant\u0131lar kar\u015f\u0131s\u0131nda stres tepkileri g\u00f6stermek normaldir. Travmatik olay bittikten 20-30 g\u00fcn sonras\u0131nda bile (bazen aylarca ve y\u0131llarca) devam eden ruhsal sorunlar, Travma Sonras\u0131 Stres Bozuklu\u011fu (TSSB) olarak adland\u0131r\u0131l\u0131r. Akut stres ya\u015fayanlar\u0131n y\u00fczde 15\u2019inde (1\/7) TSSB \u00e7\u0131kmaktad\u0131r. TSSB\u2019de anksiyete (kayg\u0131), psikosomatik bozukluklar ve a\u011f\u0131r depresyon da g\u00f6r\u00fclebilir\u2026 \u0130lk olarak Vietnam Sava\u015f\u0131 sonras\u0131 1970\u2019li y\u0131llarda tan\u0131mlanm\u0131\u015ft\u0131r. G\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 y\u00fczde 10 kadard\u0131r.<\/span><\/p>\n

2012 y\u0131l\u0131nda, u\u00e7ak kazalar\u0131ndaki fiziksel hasarlar\u0131n incelenmesi amac\u0131yla bir Boeing -727 u\u00e7a\u011f\u0131 Meksika \u00e7\u00f6l\u00fcne d\u00fc\u015f\u00fcr\u00fcld\u00fc. Yere \u00e7arpmaya saniyeler kala pilot ve teknik ekip para\u015f\u00fctle atlad\u0131. U\u00e7a\u011f\u0131n i\u00e7inde \u00e7ok say\u0131da kamera ve \u00f6l\u00e7\u00fcm aletleri ile her b\u00f6lgelerine sens\u00f6rler yerle\u015ftirilmi\u015f mankenler\u00a0(dummy)<\/em>\u00a0vard\u0131. Kaza sonras\u0131 u\u00e7a\u011f\u0131n yap\u0131sal komponentlerinin dayan\u0131kl\u0131l\u0131\u011f\u0131, \u00e7arpman\u0131n en \u00e7ok hangi b\u00f6lmeleri etkiledi\u011fi, mankenlerin maruz kald\u0131klar\u0131 travmalar\u0131n nitelikleri, vs. incelenerek \u00f6nemli bilgiler elde edildi. Tabii ki, cans\u0131z kokpit ekiplerinde ve yolcularda ne gibi akut ve kronik ruhsal \u00f6rselenmeler oldu\u011funu \u00f6l\u00e7mek m\u00fcmk\u00fcn olamad\u0131. K\u00fclt\u00fcr\u00fcm\u00fczde \u2018derin ac\u0131lar\u0131n dilsiz oldu\u011fu\u2019 s\u00f6zleri, psikolojik yaralanmalar\u0131n bast\u0131r\u0131lm\u0131\u015f t\u00fcr\u00fcn\u00fc i\u015faret eder. Ruhsal yaralanman\u0131n uzun zaman dilimlerine yay\u0131lan bi\u00e7imi olan TSSB\u2019nin bat\u0131 dillerindeki mottosu \u015fudur: \u2018Yaralar\u0131n hepsi g\u00f6r\u00fcl\u00fcr de\u011fildir.\u2019\u00a0(Not all wounds are visible\u2026 Invisible scars…)<\/em><\/p>\n

Havac\u0131l\u0131k tarihinde binlerce trajik u\u00e7u\u015f kazas\u0131 olmu\u015f, \u00f6lmedilerse, olaylar\u0131n ma\u011fdurlar\u0131nda ve \u015fahit olanlarda derin yaralar a\u00e7m\u0131\u015ft\u0131r. U\u00e7ak ka\u00e7\u0131rma, bombal\u0131 sabotaj ve intihar dal\u0131\u015flar\u0131 bi\u00e7iminde yap\u0131lan (\u00e7o\u011fu ter\u00f6rist, baz\u0131lar\u0131 psikopatolojik) eylemler, medya arac\u0131l\u0131\u011f\u0131yla en ince ayr\u0131nt\u0131s\u0131na kadar ve dramatik g\u00f6rsellerle destekli bi\u00e7imde anlat\u0131ld\u0131\u011f\u0131 i\u00e7in, olay\u0131n i\u00e7inde olmayan insanlarda bile travma yaratmaktad\u0131r. Art\u0131k bu t\u00fcr olaylar\u0131n ma\u011fdurlar\u0131 sadece kazazedeler de\u011fildir; kazada yanaca\u011f\u0131, bin par\u00e7aya b\u00f6l\u00fcnece\u011fi ve saniyeler i\u00e7inde yok olaca\u011f\u0131 endi\u015feleri ta\u015f\u0131yan milyarlarca insand\u0131r. Havayolu \u015firketleri ve devletler de ter\u00f6rist eylemleri \u00f6nlemek ad\u0131na paranoyalara girip g\u00fcvenlik \u00f6nlemlerini s\u0131k\u0131la\u015ft\u0131rd\u0131k\u00e7a naif insanlar\u0131n kayg\u0131lar\u0131 daha da artmaktad\u0131r.<\/p>\n

TSSB semptomlar<\/strong>\u0131:<\/strong>\u00a0Travmatik olay\u0131n her vesileyle s\u0131k s\u0131k an\u0131msanmas\u0131, korkutucu sahnelerin zihinde canlanmas\u0131\u00a0(flash-back)<\/em>, olay tekrar ya\u015fan\u0131yormu\u015f gibi hissederek irkilme ve s\u0131\u00e7ramalar, olayla ilgili r\u00fcyalar, k\u00e2buslar, uyku bozuklu\u011fu; sinirlilik, \u00f6fke patlamalar\u0131, odaklanma bozuklu\u011fu, olay\u0131 konu\u015fmaktan ka\u00e7\u0131nma, zorlay\u0131c\u0131 d\u00fc\u015f\u00fcnceler, unutkanl\u0131k, toplumdan \u00e7ekilme, yabanc\u0131la\u015fma, ilgisizlik, duygusal k\u00fcntle\u015fme, i\u015ftahs\u0131zl\u0131k, halsizlik, depresyon, alkol, t\u00fct\u00fcn ve ila\u00e7 t\u00fcketiminde art\u0131\u015f, vs\u2026<\/p>\n

Bir kazan\u0131n olu\u015fu esnas\u0131nda pilot, m\u00fcrettebat ve yolcular\u0131n akut stres tepkileri 4 \u00e7e\u015fit olarak belirlenmi\u015ftir: Donakalanlar, \u00e7\u0131lg\u0131nla\u015fanlar, g\u00fcvenlik edebiyat\u0131 yapanlar ve dengesini kaybetmeyenler. Bunlardan ilk \u00fc\u00e7\u00fc bi\u00e7imindeki patolojik tutumlar profesyonel u\u00e7ucularda nadiren g\u00f6r\u00fcl\u00fcr; yolcular ise dengesiz ve kontrols\u00fcz davranmaya daha yatk\u0131nd\u0131rlar.<\/p>\n

Yolcular:<\/strong>\u00a0Uluslararas\u0131 u\u00e7u\u015flarda farkl\u0131 dil, k\u00fclt\u00fcr, ya\u015f ve ki\u015filik kategorilerindeki yolcular otorite tan\u0131mayan ve her u\u00e7u\u015f olay\u0131n\u0131 abartmaya e\u011filimli insanlard\u0131r. Baz\u0131lar\u0131n\u0131n ciddi psikiyatrik hastal\u0131klar\u0131 olabilir. Genellikle u\u00e7u\u015f s\u00fcresince gergin, kayg\u0131l\u0131 ve kontrolleri g\u00fc\u00e7t\u00fcr; basit bir t\u00fcrb\u00fclansta bile kolayca pani\u011fe kap\u0131labilirler. Kalk\u0131\u015f s\u0131ras\u0131nda motorlar\u0131 duran veya bomba ihbar\u0131 nedeniyle ini\u015fe ge\u00e7en u\u00e7aklar\u0131n yolcular\u0131 \u00e7o\u011fu zaman kabin ekiplerinin koydu\u011fu kurallara (s\u0131rayla \u00e7\u0131k\u0131\u015f, ya\u015fl\u0131 ve \u00e7ocuklara \u00f6ncelik, vs.) uymaz; panik i\u00e7inde hep birlikte \u00e7\u0131k\u0131\u015f kap\u0131lar\u0131na ve\u00a0slide<\/em>\u2019lara y\u00fcklenir, s\u0131k\u0131\u015farak ve ezilerek \u00f6lenler bile olabilir…<\/p>\n

U\u00e7u\u015f ekipleri:<\/strong>\u00a0Genelde profesyonel ki\u015filer olan pilotlar ve kabin memurlar\u0131 ise u\u00e7u\u015f streslerine kar\u015f\u0131 g\u00f6rece dayan\u0131kl\u0131d\u0131rlar ve \u201cdengesini kaybetmeyenler\u201d grubunda yer al\u0131rlar. U\u00e7a\u011f\u0131n anormal durumlar\u0131nda ve kritik kaza \u00f6ncesinde son ana kadar pani\u011fe kap\u0131lmadan, u\u00e7a\u011f\u0131 ve i\u00e7indekileri kurtarmak i\u00e7in ellerinden geleni yaparlar. Kaza s\u0131ras\u0131nda kumandalar\u0131 b\u0131rakan, \u00e7\u0131lg\u0131nca davranan pilota pek rastlanmam\u0131\u015ft\u0131r. Bu, k\u0131smen u\u00e7ak ve yolcular\u0131n sel\u00e2metiyle ilgili sorumlulu\u011fun kendilerinde oldu\u011fu hissiyle; k\u0131smen de u\u00e7a\u011f\u0131n teknik emniyet sistemlerini bilmelerinin getirdi\u011fi g\u00fcvenle ilgili olsa gerektir. Ama tabii ki bu bir kural de\u011fildir; 2005 y\u0131l\u0131nda Tunus\u2019un Cerba Adas\u0131ndan \u0130talya\u2019n\u0131n Bari kentine giden Tunus Havayollar\u0131na ait u\u00e7a\u011f\u0131n kaptan pilotu, Sicilya \u00fczerindeyken yak\u0131t\u0131n\u0131n azald\u0131\u011f\u0131n\u0131 g\u00f6rerek pani\u011fe kap\u0131ld\u0131 ve kumandalar\u0131 b\u0131rakarak dua etmeye ba\u015flad\u0131. U\u00e7a\u011f\u0131 denize indirdi; 23 ki\u015fi kurtulurken 16 ki\u015fi \u00f6ld\u00fc. Ses kay\u0131tlar\u0131na g\u00f6re pilot panik i\u00e7inde Allah\u2019\u0131 ve peygamberi yard\u0131ma \u00e7a\u011f\u0131rmaktayd\u0131. U\u00e7a\u011f\u0131 denize indirerek 23 ki\u015fiyi kurtad\u0131\u011f\u0131 i\u00e7in kahraman il\u00e2n edildiyse de, 2009 Mart ay\u0131nda biten mahkemesinde, u\u00e7a\u011f\u0131 yak\u0131ndaki Palermo Havaalan\u0131na indirmedi\u011fi i\u00e7in 10 y\u0131l hapis cezas\u0131 ald\u0131.<\/p>\n

Kaza sonras<\/strong>\u0131 dibrifing<\/strong><\/p>\n

Sivil u\u00e7ak kazalar\u0131ndan sonra baz\u0131 havayolu \u015firketleri ilk 1-3 g\u00fcn i\u00e7inde, \u2018Kaza Sonras\u0131 Dibrifing\u2019 ba\u015fl\u0131\u011f\u0131 alt\u0131nda kazazede ve aileler i\u00e7in bilgilendirme ve de\u015farj ama\u00e7l\u0131 toplant\u0131lar yaparlar. Akut stres tepkilerinin y\u00f6netimi amac\u0131yla ayn\u0131 ac\u0131y\u0131 ya\u015fayan insanlar\u0131 bir araya getirmek, empati, payla\u015f\u0131m ve tepkilerin normalizasyonu y\u00f6n\u00fcnden yararl\u0131 olur. Bir lider (psikolog, moderat\u00f6r) y\u00f6netimindeki bu toplant\u0131larda hedeflenen ama\u00e7lar, ilke ve usuller \u015f\u00f6yledir:<\/p>\n

1.<\/strong>\u00a0Kaza ge\u00e7iren veya kazada yak\u0131nlar\u0131n\u0131 kaybeden ki\u015filerin d\u00fc\u015f\u00fcnce ve duygular\u0131n\u0131 ifade etme f\u0131rsat\u0131, destek ve g\u00fcven vermek,<\/p>\n

2.<\/strong>\u00a0Sorular sorarak konu\u015fturmak, i\u00e7ini d\u00f6kme ve payla\u015fma yoluyla kay\u0131plar\u0131n ac\u0131s\u0131n\u0131 hafifletmeye \u00e7al\u0131\u015fmak,<\/p>\n

3.<\/strong>\u00a0TSSB belirtilerini anlat\u0131p, bunlar\u0131n do\u011fal \/ normal oldu\u011funu ve zaman i\u00e7inde azalaca\u011f\u0131n\u0131 \u00f6\u011fretmek,<\/p>\n

4.<\/strong>\u00a0Tevekk\u00fcl, tel\u00e2fi, y\u00fcceltme ve rasyonalizasyon gibi olgun savunma mekanizmalar\u0131n\u0131 harekete ge\u00e7irmek,<\/p>\n

5.<\/strong>\u00a0H\u0131r\u00e7\u0131n ve histerik tepkilerden uzakla\u015fmay\u0131, makul ba\u015fa \u00e7\u0131kma stratejilerini \u00f6\u011fretmek\u2026<\/p>\n

Di<\/strong>\u011fer y\u00f6ntemler<\/strong><\/p>\n

1.<\/strong>\u00a0Kaza ana \u00fcs d\u0131\u015f\u0131ndaki ba\u015fka \u015fehir veya \u00fclkelerde olduysa, oraya Aile Destek Timlerinin ivedi g\u00f6nderilip hastanelerde veya b\u00fcrokraside \u00e7\u0131kan zorluklarla u\u011fra\u015fmalar\u0131 (cenaze nakli, hastane masraflar\u0131, kaybolan pasaportlar\u0131n \u00e7\u0131kar\u0131lmas\u0131, hukuki sorunlar, vs.) ve sa\u011f kalanlara kendi dillerinde psikolojik destek verilmesi gerekir,<\/p>\n

2.<\/strong>\u00a0Sonraki g\u00fcnlerde yap\u0131lan toplu cenaze t\u00f6renleri, dini rit\u00fceller, mum yakma, \u00e7i\u00e7ek b\u0131rakma vb. gibi eylemler de dibrifing e\u015fde\u011feridir ve i\u015flevseldir. Buraya havayolu \u015firketi temsilcilerinin de kat\u0131lmas\u0131, \u00f6lenlerin yak\u0131nlar\u0131na psikolojik yard\u0131m\u0131n s\u00fcrd\u00fcr\u00fclmesi, tazminat da dahil ekonomik destekler verilmesi, psikolojik tepkilerin azalt\u0131lmas\u0131nda yararl\u0131 olur,<\/p>\n

3.<\/strong>\u00a0Kazayla do\u011frudan ilgisi olmayan ve seyirci durumundaki insanlar\u0131n bile travmatize olacaklar\u0131 hesaba kat\u0131larak, TSSB hem ki\u015fisel hem de kitlesel pl\u00e2nda ele al\u0131nmal\u0131d\u0131r. Bu tek ba\u015f\u0131na bir \u015firketin ba\u015farabilece\u011fi bir i\u015f olmad\u0131\u011f\u0131ndan, ulusal sivil havac\u0131l\u0131k kurumunun organizasyonunu, \u00f6zel kurulu\u015flarla anla\u015fmalar yap\u0131lmas\u0131n\u0131 ve e\u011fitimli \/ deneyimli personelin bulundurulmas\u0131n\u0131 gerektirir,<\/p>\n

4.<\/strong>\u00a0Stres y\u00f6netimi<\/u>: Bu i\u015fi yapacak olan m\u00fcdahale ekipleri, doktor, psikiyatrist, psikolog ve din adam\u0131 gibi \u00fcyelerden olu\u015fmal\u0131d\u0131r. Sorumluluklar\u0131 sadece havac\u0131l\u0131k kazalar\u0131yla s\u0131n\u0131rl\u0131 olmay\u0131p, deprem, sel, yang\u0131n, b\u00fcy\u00fck kazalar, sava\u015flar ve ter\u00f6rist eylemleri de kapsamal\u0131d\u0131r,<\/p>\n

5.<\/strong>\u00a0Tedavi<\/u>: Dibrifing ve di\u011fer desteklerle yat\u0131\u015fmayan olgular\u0131n (depresyon, psikosomatik bozukluklar, yo\u011fun anksiyete, panik, histeri, korku, tak\u0131nt\u0131, uyku ve i\u015ftah bozukluklar\u0131, patolojik yas, vs.) psikiyatrik tedaviye y\u00f6nlendirilmesi gerekir. Psikoterapi, EMDR veya ila\u00e7 tedavisi uzman kontrol\u00fcnde s\u00fcrd\u00fcr\u00fclmelidir. Ama ma\u011fdur ki\u015filer i\u00e7in en \u00f6nemli ila\u00e7, kazas\u0131z, kavgas\u0131z, sakin bir ortam temin etmeye \u00e7al\u0131\u015fmakt\u0131r\u2026<\/p>\n

Sons\u00f6z<\/strong><\/p>\n

Bu yaz\u0131da havac\u0131l\u0131k kazalar\u0131 ba\u011flam\u0131nda \u00f6zetlenen akut ve TSSB problemi, trafik kazalar\u0131, depremler, maden facialar\u0131, tecav\u00fcz, cinnet, toplu katliam, i\u015fkence ve \u015fiddet gibi a\u011f\u0131r travmatik olaylar\u0131n da sonucu ortaya \u00e7\u0131kabilir. Son y\u0131llarda \u00fclkemizin i\u00e7inde bulundu\u011fu sanc\u0131l\u0131 s\u00fcre\u00e7teki ter\u00f6rist eylemler, sava\u015flar, askeri ve sivil vah\u015fet sahneleri, hem ma\u011fdurlar\u0131 hem de \u015fahitleri derinden yaralamaktad\u0131r.<\/p>\n

Art\u0131k bu olaylar\u0131n i\u00e7inde fiziken yaralanan ve \u00f6len binlerce insandan \u00e7ok daha fazla say\u0131da, onlar\u0131n sevenleri, olaylar\u0131n \u015fahitleri veya uzaktan izleyicisi durumunda olan milyonlarca naif insanlar\u0131m\u0131z vard\u0131r. Bunlar ruhen yaralanmakta, beklenti anksiyetesi i\u00e7inde huzursuz g\u00fcnler ya\u015famaktad\u0131r… Bu anksiyete art\u0131k kitlesel boyutlara varm\u0131\u015ft\u0131r. Bug\u00fcn belki bunlar\u0131 idrak edemeyen ve yar\u0131n mutlaka alg\u0131layacak olan \u00e7ocuklar\u0131m\u0131zda y\u0131llar boyu s\u00fcrecek psikolojik bozukluklar (TSSB) \u00e7\u0131kmas\u0131 olas\u0131d\u0131r; toplumsal depresyonu \u00f6nleme sorumlulu\u011fu devlet adamlar\u0131nda ve eri\u015fkin ku\u015faklardad\u0131r. Bizi y\u00f6netenlerden bar\u0131\u015f dolu, sakin, dingin ve huzurlu bir ya\u015fam kurmalar\u0131n\u0131 umuyor ve bekliyoruz.<\/p>\n","protected":false},"excerpt":{"rendered":"

Yazar : Prof. Dr. Muzaffer \u00c7eting\u00fc\u00e7 Yay\u0131nlanma tarihi : 9 Ocak 2017 https:\/\/www.airkule.com\/yazar\/AKUT-STRES-VE-TRAVMA-SONRASI-STRES-BOZUKLUGU\/1161\/ G\u00fcnl\u00fck rutin ya\u015fam olaylar\u0131n\u0131n \u00e7ok \u00fcst\u00fcnde s\u0131k\u0131nt\u0131 ve korku yaratan travmatik olaylar (kendine, yak\u0131nlar\u0131na veya ba\u015fkalar\u0131na y\u00f6nelik tehdit, \u015fiddet, tecav\u00fcz, \u00f6ld\u00fcrme, yakma, y\u0131kma, kaza, do\u011fal afet, vs.) herkeste \u2018akut stres\u2019 denilen tepkiler yarat\u0131r. \u00d6l\u00fcmle y\u00fcz y\u00fcze gelme veya s\u0131ra d\u0131\u015f\u0131 korkutucu, anormal ya\u015fant\u0131lar kar\u015f\u0131s\u0131nda stres tepkileri g\u00f6stermek […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-3706","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/3706","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3706"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/3706\/revisions"}],"predecessor-version":[{"id":3707,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/3706\/revisions\/3707"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3706"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3706"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3706"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}