{"id":3001,"date":"2023-10-17T08:59:27","date_gmt":"2023-10-17T08:59:27","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?p=3001"},"modified":"2025-11-04T09:16:11","modified_gmt":"2025-11-04T09:16:11","slug":"acceptance-and-commitment-therapy-a-promising-approach-for-those-living-with-long-covid","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/sk\/2023\/10\/acceptance-and-commitment-therapy-a-promising-approach-for-those-living-with-long-covid\/","title":{"rendered":"Terapia akcept\u00e1cie a z\u00e1v\u00e4zku: S\u013eubn\u00fd pr\u00edstup pre t\u00fdch, ktor\u00ed \u017eij\u00fa s long-COVIDom"},"content":{"rendered":"<p><strong>Amy Barradell, University Hospitals of Leicester NHS Trust<\/strong><\/p>\n<p><strong>Keby som povedala long-Covid, \u010do by to pre v\u00e1s znamenalo?<\/strong><\/p>\n<p>Podskupina \u013eud\u00ed, ktor\u00ed sa nakazili COVID-19, na\u010falej poci\u0165uje oslabuj\u00face sympt\u00f3my viac ako 4 t\u00fd\u017edne po ich ak\u00fatnej infekcii. Be\u017ene uv\u00e1dzaj\u00fa fyzick\u00e9 (napr. d\u00fdchavi\u010dnos\u0165, \u00fanava) aj psychick\u00e9 (napr. \u00fazkos\u0165, kognit\u00edvne poruchy) <a href=\"https:\/\/www.thelancet.com\/journals\/lanres\/article\/PIIS2213-2600(21)00383-0\/fulltext\">sympt\u00f3my<\/a>. T\u00ed, ktor\u00ed maj\u00fa tieto pr\u00edznaky, to naz\u00fdvaj\u00fa \u201elong-COVID\u201c.<\/p>\n<p><!--more--><\/p>\n<h2>Z mojej sk\u00fasenosti\u2026<\/h2>\n<p>Pr\u00e1ca na klinike zameranej na long-COVID mi uk\u00e1zala, \u017ee \u013eudia maj\u00fa probl\u00e9m akceptova\u0165 svoje nov\u00e9 sympt\u00f3my (a d\u00f4sledky ich sympt\u00f3mov), \u010do br\u00e1ni ich strat\u00e9gi\u00e1m sebamana\u017ementu. Zameriavaj\u00fa sa na to, \u010do mohli robi\u0165 pred \u201elong-COVIDom\u201c a ako sa ich \u017eivot od stanovenia diagn\u00f3zy zmenil k hor\u0161iemu. To nazna\u010duje vyh\u00fdbanie sa (t. j. pokus alebo t\u00fa\u017ebu potla\u010di\u0165 ne\u017eiaduce vn\u00fatorn\u00e9 z\u00e1\u017eitky, ako s\u00fa em\u00f3cie, my\u0161lienky, spomienky a telesn\u00e9 vnemy) a tendenciu \u013eud\u00ed s\u00fastredi\u0165 sa na formu sympt\u00f3mov namiesto na funkciu sympt\u00f3mov (t. j. indik\u00e1tor tela na zmenu vlastn\u00e9ho spr\u00e1vania). Nazna\u010duje to, \u017ee \u013eudia nie s\u00fa otvoren\u00ed t\u00fdmto sk\u00fasenostiam a vyh\u00fdbaj\u00fa sa \u017eitiu v pr\u00edtomnom okamihu.<\/p>\n<p><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2021.03.22.21254057v2\">Viac ako 25% \u013eud\u00ed<\/a>, ktor\u00ed boli hospitalizovan\u00ed s COVID-19, m\u00e1 pretrv\u00e1vaj\u00face pr\u00edznaky depresie aj \u0161es\u0165 mesiacov po ich prepusten\u00ed. Ke\u010f\u017ee depresia je spojen\u00e1 s <a href=\"https:\/\/www.mindwell-leeds.org.uk\/myself\/exploring-your-mental-health\/depression\/what-keeps-depression-going\/\">vyh\u00fdban\u00edm sa aktivite<\/a> (t. j. rozhodnut\u00edm nevst\u00fapi\u0165 do situ\u00e1cie), ukazuje to, \u017ee \u013eudia sa nemusia zap\u00e1ja\u0165 do potrebn\u00fdch aktiv\u00edt.<\/p>\n<p><strong>\u00daloha psychologickej flexibility v long-COVID<\/strong><\/p>\n<p>Psychologick\u00e1 flexibilita je mechanizmom \u00fa\u010dinku terapie akcept\u00e1cie a z\u00e1v\u00e4zku (<a href=\"https:\/\/www.ijpsy.com\/volumen10\/num1\/256.html\">Acceptance and Commitment Therapy &#8211; ACT<\/a>). Zah\u0155\u0148a tri piliere: (1) povzbudenie otvorenosti vo\u010di sk\u00fasenostiam, (2) uvedomenie si pr\u00edtomn\u00e9ho okamihu a (3) zapojenie sa do hodnotn\u00fdch aktiv\u00edt. Ako je uveden\u00e9 vy\u0161\u0161ie, zd\u00e1 sa, \u017ee tieto piliere s\u00fa u \u013eud\u00ed \u017eij\u00facich s long-COVIDom nevyv\u00e1\u017een\u00e9, a preto je d\u00f4le\u017eit\u00e9 ich rie\u0161i\u0165. ACT mo\u017eno preto pou\u017ei\u0165 na pomoc \u013eu\u010fom zmeni\u0165 vz\u0165ah, ktor\u00fd maj\u00fa s ich tr\u00e1pen\u00edm (t. j. zn\u00ed\u017ei\u0165 ich tendencie ku vyh\u00fdbanu sa ur\u010dit\u00fdm sk\u00fasenostiam), vybudova\u0165 ich prijatie nov\u00e9ho \u201enorm\u00e1lneho\u201c (t. j. zv\u00fd\u0161i\u0165 ich povedomie o pr\u00edtomnom okamihu) a motivova\u0165 a posilni\u0165 k vykonaniu zmien spr\u00e1vania, ktor\u00e9 s\u00fa pre nich d\u00f4le\u017eit\u00e9 (t. j. zapoji\u0165 sa do hodnotn\u00fdch aktiv\u00edt). <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34931160\/\">ACT v long-COVIDe napreduje<\/a>, \u00fa\u010dastn\u00edci hl\u00e1sili zlep\u0161enie pohody, st\u00e1le poci\u0165uj\u00fa \u00fazkos\u0165 s\u00favisiacu s long-COVIDom, ale c\u00edtili sa schopnej\u0161\u00ed vyrovna\u0165 sa so v\u0161eobecn\u00fdm psychick\u00fdm utrpen\u00edm (ako je \u00fazkos\u0165).<\/p>\n<h2>Pou\u017e\u00edvanie ACT na klinike long-COVID: Predstavujeme v\u00e1m Jo<\/h2>\n<p>Ke\u010f som sa prv\u00fdkr\u00e1t stretla s Jo, za\u017e\u00edvala pravideln\u00e9 recid\u00edvy sympt\u00f3mov. Aby sme zachovali anonymitu, Jo zastupuje cel\u00fd rad \u013eud\u00ed, s ktor\u00fdmi som pracovala na klinike long-COVID. Jej najviac oslabuj\u00facimi pr\u00edznakmi boli d\u00fdchavi\u010dnos\u0165 a \u00fanava, ktor\u00e9 ve\u013emi s\u0165a\u017eovali ka\u017edodenn\u00e9 \u010dinnosti. Jo sa b\u00e1la recid\u00edv a vedome sa sna\u017eila vyhn\u00fa\u0165 v\u0161etk\u00e9mu, \u010do by ich zhor\u0161ilo (t. j. vyh\u00fdbanie sa sk\u00fasenostiam, vyh\u00fdbanie sa pr\u00edtomn\u00e9mu okamihu). Tr\u00e1vila m\u00e1lo \u010dasu aktivitami, ktor\u00e9 jej d\u00e1vali rados\u0165 a zmysel (t. j. vyh\u00fdbala sa hodnotn\u00fdm aktivit\u00e1m).<\/p>\n<p>Na na\u0161ich spolo\u010dn\u00fdch stretnutiach sme sa venovali ka\u017edej zo zlo\u017eiek ACT:<\/p>\n<ul>\n<li><strong>Kognit\u00edvna def\u00fazia<\/strong> (t. j. v\u0161\u00edmanie si my\u0161lienok namiesto toho, aby ste sa nimi nechali pohlti\u0165 a schopnos\u0165 necha\u0165 my\u0161lienky prich\u00e1dza\u0165 a odch\u00e1dza\u0165, namiesto toho, aby ste sa v nich dr\u017eali) \u2013 rozl\u00ed\u0161enie medzi my\u0161lienkami\/pocitmi a skuto\u010dn\u00fdmi z\u00e1\u017eitkami (nie s\u00fa nevyhnutne rovnak\u00e9!)<\/li>\n<li><strong>Kontakt s pr\u00edtomn\u00fdm okamihom<\/strong> \u2013 osvojenie si strat\u00e9gie v\u0161\u00edmavosti, ktor\u00e9 v\u00e1s ukotvia vo va\u0161ich pre\u017e\u00edvan\u00fdch zmyslov\u00fdch z\u00e1\u017eitkoch (t. j. uvedomenie si pr\u00edtomn\u00e9ho okamihu).<\/li>\n<li><strong>Sk\u00famanie hodn\u00f4t<\/strong> \u2013 identifikova\u0165 oblast\u00ed \u017eivota, ktor\u00e9 s\u00fa pre v\u00e1s najd\u00f4le\u017eitej\u0161ie.<\/li>\n<li><strong>Prijatie z\u00e1v\u00e4zku k aktivite<\/strong> \u2013 stanovenie si cie\u013ea spr\u00e1vania, ktor\u00e9 s\u00fa v s\u00falade s va\u0161imi hodnotami.<\/li>\n<li><strong>Ja ako kontext<\/strong> \u2013 nadviazanie kontaktu so svoj\u00edm \u201epozoruj\u00facim ja\u201c a schopnos\u0165 vidie\u0165 svoje my\u0161lienky s odstupom (z presnej\u0161ej perspekt\u00edvy) bez toho, aby sa do nich zamotali.<\/li>\n<li><strong>Akcept\u00e1cia<\/strong> \u2013 schopnos\u0165 presta\u0165 z\u00e1pasi\u0165 s t\u00fdm, \u010do je mimo va\u0161u kontrolu a schopnos\u0165 znovu sa zamera\u0165 na to, \u010do je pod va\u0161ou kontrolou (va\u0161e spr\u00e1vanie).<\/li>\n<\/ul>\n<p>Na druhom stretnut\u00ed si Jo stanovila dva ciele spr\u00e1vania v s\u00falade s jej z\u00e1kladn\u00fdmi hodnotami. Pou\u017eila som <a href=\"https:\/\/motivationalinterviewing.org\/understanding-motivational-interviewing\">techniku motiva\u010dn\u00fdch rozhovorov<\/a>, aby som ju podporil pri vytv\u00e1ran\u00ed <a href=\"https:\/\/www.mindtools.com\/a4wo118\/smart-goals\">SMART cie\u013ea<\/a> a prostredn\u00edctvom techniky <a href=\"https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/10463283.2020.1808936\">\u201cke\u010f-tak pl\u00e1novania\u201d<\/a> sme spolo\u010dne prebrali jej pr\u00edpadn\u00e9 obavy oh\u013eadne schopnosti dosahova\u0165 stanoven\u00e9 ciele.<\/p>\n<p>O \u0161tyri t\u00fd\u017edne nesk\u00f4r mi s hrdos\u0165ou ozn\u00e1mila, \u017ee svoje ciele splnila. Do svojho ka\u017edodenn\u00e9ho \u017eivota za\u010dlenila nieko\u013eko aktiv\u00edt zameran\u00fdch na mindfulness (cvi\u010denie s listami na potoku, denn\u00edk v\u010fa\u010dnosti a 5 min\u00fat jogy). Za\u017eila zv\u00fd\u0161en\u00fa psychologick\u00fa flexibilitu ke\u010f je \u010dlovek psychologicky flexibiln\u00fd, bude sa rozhodova\u0165 sk\u00f4r na z\u00e1klade svojich hodn\u00f4t a dlhodob\u00fdch presved\u010den\u00ed ne\u017e okam\u017eit\u00fdch kr\u00e1tkodob\u00fdch em\u00f3ci\u00ed, ktor\u00e9 pre\u017e\u00edva), zn\u00ed\u017eili sa pr\u00edznaky depresie a zv\u00fd\u0161ila d\u00f4vera v sebamana\u017ement aj mimo seden\u00ed.<\/p>\n<h2>Odpor\u00fa\u010dania pre zdravotn\u00edckych pracovn\u00edkov, ktor\u00ed podporuj\u00fa \u013eud\u00ed s long-COVIDom:<\/h2>\n<ol>\n<li><strong>Nezab\u00fadajte na d\u00f4le\u017eitos\u0165 biopsychosoci\u00e1lneho hodnotenia<\/strong> \u2013 skuto\u010dn\u00e9 pochopenie komplexnosti sympt\u00f3mov long-COVIDu u osoby a d\u00f4sledkov t\u00fdchto sympt\u00f3mov je k\u013e\u00fa\u010dom k identifik\u00e1cii strat\u00e9gi\u00ed mana\u017ementu zameran\u00fdch na pacienta. Nebojte sa kl\u00e1s\u0165 ot\u00e1zky ako: \u201eS ak\u00fdm pr\u00edznakom z\u00e1pas\u00edte najviac?\u201c; \u201eAk\u00fd je vplyv va\u0161ej d\u00fdchavi\u010dnosti\/\u00fanavy\/mozgovej hmly na v\u00e1\u0161 \u017eivot?\u201c; \u201eAk\u00e9 my\u0161lienky v\u00e1m be\u017eia hlavou, ke\u010f poci\u0165ujete d\u00fdchavi\u010dnos\u0165\/\u00fanavu\/mozgov\u00fa hmlu\u201c?<\/li>\n<li><strong>Zv\u00e1\u017ete meranie psychologickej flexibility<\/strong> \u2013 komplexn\u00e9 hodnotenie procesov terapie akcept\u00e1cie a z\u00e1v\u00e4zku (CompACT) je r\u00fdchlym a overen\u00fdm n\u00e1strojom na zachytenie psychologickej flexibility. M\u00f4\u017eete r\u00fdchlo identifikova\u0165, ktor\u00fd z pilierov psychologickej flexibility je potrebn\u00e9 zv\u00fd\u0161i\u0165, a pod\u013ea toho napl\u00e1nova\u0165 strat\u00e9giu mana\u017ementu (napr. ak sa vyh\u00fdbaj\u00fa hodnotn\u00fdm aktivit\u00e1m, presk\u00famajte, ak\u00e9 s\u00fa ich z\u00e1kladn\u00e9 hodnoty a pom\u00f4\u017ete im stanovi\u0165 SMART cie\u013e).<\/li>\n<li><strong>Poskytnite\/navrhnite mindfulness cvi\u010denia<\/strong> \u2013 tieto cvi\u010denia m\u00f4\u017eu v ACT ve\u013emi v\u00fdrazne \u013eu\u010fom pom\u00f4c\u0165 vybudova\u0165 si piliere psychologickej flexibility. V z\u00e1vislosti od problematickej oblasti m\u00f4\u017eete pon\u00faknu\u0165 vhodn\u00e9 cvi\u010denie ako napr\u00edklad:\n<ol>\n<li>Kognit\u00edvna def\u00fazia \u2013 <a href=\"https:\/\/www.youtube.com\/watch?v=r1C8hwj5LXw\">Listy<\/a> v potoku<\/li>\n<li>Kontakt s pr\u00edtomn\u00fdm okamihom \u2013 <a href=\"https:\/\/www.youtube.com\/watch?v=CBYhuhSiO8Q\">V\u0161imnite<\/a> si 5 vec\u00ed<\/li>\n<li>Ja ako kontext \u2013 \u201e<a href=\"https:\/\/www.youtube.com\/watch?v=nBPPr1hsbMM\">The Stageshow metaphor<\/a>\u201c<\/li>\n<\/ol>\n<\/li>\n<li><strong>Dr\u017ete krok s usmerneniami o osved\u010den\u00fdch postupoch<\/strong> \u2013 rovnako ako v pr\u00edpade mnoh\u00fdch in\u00fdch zdravotn\u00fdch stavov sa d\u00f4kazov\u00e1 z\u00e1klad\u0148a long-COVIDu neust\u00e1le vyv\u00edja, tak\u017ee dr\u017ete krok s literat\u00farou a usmerneniami pre klinick\u00fa prax. D\u00f4kazy o ACT prib\u00fadaj\u00fa!<\/li>\n<li><strong>Postarajte sa aj o seba<\/strong> \u2013 pr\u00e1ca s \u013eu\u010fmi, ktor\u00ed maj\u00fa long-Covid, m\u00f4\u017ee by\u0165 n\u00e1ro\u010dn\u00e1, preto sa uistite, \u017ee m\u00e1te pravideln\u00fa superv\u00edziu alebo \u201edebr\u00edfing\u201c s niek\u00fdm, komu d\u00f4verujete. Nielen\u017ee je to u\u017eito\u010dn\u00e9 pri diskusii o konkr\u00e9tnych pacientoch, ale tie\u017e v\u00e1m to pom\u00e1ha zosta\u0165 vo va\u0161ej praxi psychicky v poriadku.<\/li>\n<\/ol>\n<p><em>[Prelo\u017eila Zuzana Dankulincov\u00e1]<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Amy Barradell, University Hospitals of Leicester NHS Trust If I were to say to you, Long-Covid, what would that mean to you? A sub-set of people that contracted Coronavirus Disease 2019 (COVID-19), have continued to experience debilitating symptoms for [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":3034,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[38,58,13,36,56],"tags":[],"class_list":["post-3001","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-acceptance-and-commitment-therapy","category-covid","category-interventions","category-mental-health","category-public-health"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"sk","enabled_languages":["en","id","my","bg","zh","hr","cz","da","de","es","fr","gr","he","it","ja","kr","lv","lt","hu","nl","no","pl","pt","ro","ru","sk","sr","fi","et","sv","tr","uk","hi","sw","ta"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"id":{"title":true,"content":true,"excerpt":false},"my":{"title":true,"content":true,"excerpt":false},"bg":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false},"hr":{"title":false,"content":false,"excerpt":false},"cz":{"title":true,"content":true,"excerpt":false},"da":{"title":false,"content":false,"excerpt":false},"de":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"fr":{"title":true,"content":true,"excerpt":false},"gr":{"title":false,"content":false,"excerpt":false},"he":{"title":true,"content":true,"excerpt":false},"it":{"title":true,"content":true,"excerpt":false},"ja":{"title":true,"content":true,"excerpt":false},"kr":{"title":false,"content":false,"excerpt":false},"lv":{"title":true,"content":true,"excerpt":false},"lt":{"title":false,"content":false,"excerpt":false},"hu":{"title":false,"content":false,"excerpt":false},"nl":{"title":true,"content":true,"excerpt":false},"no":{"title":false,"content":false,"excerpt":false},"pl":{"title":true,"content":true,"excerpt":false},"pt":{"title":false,"content":false,"excerpt":false},"ro":{"title":false,"content":false,"excerpt":false},"ru":{"title":true,"content":true,"excerpt":false},"sk":{"title":true,"content":true,"excerpt":false},"sr":{"title":false,"content":false,"excerpt":false},"fi":{"title":true,"content":true,"excerpt":false},"et":{"title":false,"content":false,"excerpt":false},"sv":{"title":false,"content":false,"excerpt":false},"tr":{"title":true,"content":true,"excerpt":false},"uk":{"title":true,"content":true,"excerpt":false},"hi":{"title":false,"content":false,"excerpt":false},"sw":{"title":false,"content":false,"excerpt":false},"ta":{"title":false,"content":false,"excerpt":false}}},"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"{:en}By Amy Barradell, University Hospitals of Leicester NHS Trust If I were to say to you, Long-Covid, what would that mean to you? 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A sub-set of people that contracted Coronavirus Disease 2019 (COVID-19), have continued to experience debilitating symptoms for more than 4 weeks following their acute infection. 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