運用認知治療改善雙極性個案之憂鬱認知及情緒的護理經驗

The Nursing Experience of Cognitive Therapy for Bipolar Patient with Depressive Episode

黃麗碧(Li-Bi Hwang) ； 蔡美菊(Mei-Chu Tsai) ； 林青蓉(Ching-Rong Lin) ； 張秀如(Hsiu-Ju Chang)

《精神衛生護理雜誌》 4卷2期 (2009/12) Pp. 47-57

https://doi.org/10.6847/TJPMHN.200912_4(2).0006

摘要

運用認知治療協助重鬱症患者改善其負向思考及憂鬱情緒，已經被證實具有實證性護理成效，但文獻中鮮少討論運用認知治療法在躁鬱症憂鬱期的患者，是否也具有相當的護理成效。本個案報告乃著重運用認知治療方法，協助一位處於憂鬱期之躁鬱症個案，透過個別會談、觀察及整體性護理評估，進行資料收集與問題確認，發現個案對自己、人際關係及事件皆抱持負面的看法，歸納出護理問題包括：自我照顧能力不足、社交隔離及潛在性對自己的暴力行為。筆者配合個案病程發展，將護理計畫區分為三個階段：協助察覺自動化思考、運用尋找支持及不支持負向想法的證據，及家庭作業方式等技巧改善個案的護理問題。
評值結果發現個案由退縮、無意願，漸漸出現願意自我探索的動機，並續發展正向思考的認知與情緒，進而改善其護理問題。提出此臨床護理經驗，建議護理人員可運用認知治療於類似個案的護理措施中，協助個案出院後仍可維持穩定情緒、合宜的人際關係，以降低因疾病復發而再次住院的機率。

關鍵字

認知治療 ； 躁鬱症 ； 憂鬱認知與情緒

並列摘要

It is well known that cognitive therapy (CT) can be used effectively to improve negative thoughts and depressed mood in patients with depressive disorder. Little is known, however, about the effectiveness of CT in clients with depressive episodes of bipolar disorder. The purpose of this case report was therefore to demonstrate the nursing experience and effectiveness of implementing CT in client with depressive episode of bipolar disorder. Through interview, observation and comprehensive nursing assessment, data collection and problem identification, the following three major nursing diagnoses were made: deficit in self-care, social isolation and risk of violence (toward self). We also found that the client’s negative thoughts were demonstrated in the dimensions of herself, social relationships and life events. Nursing interventions were implemented in assisting the client to identify automatic thoughts, clarify the evidence supporting and not supporting her negative thoughts, and to perform training assignments at home throughout her cognitive therapy training. The results revealed that the client’s motivation to perform self-exploration was increased, her thinking became more positive and her emotions improved gradually. Her personal hygiene and interpersonal relationships were also improved. The results of this case report have important implications for psychiatric mental health nurses applying CT in caring for clients with depressive episodes of bipolar disorder.

並列關鍵字

cognitive therapy ； bipolar disorder ； depressive cognition and emotion