運用認知治療於重覆自殺重鬱症患者之護理經驗

An Experience Applying Cognitive Therapy to a Suicidal Patient Suffering Major Depression

郭雅軫(Ya-Chen Kuo) ； 邱照華(Chao-Hua Chiu)

《精神衛生護理雜誌》 5卷1期 (2010/10) Pp. 48-56

https://doi.org/10.6847/TJPMHN.201010_5(1).0006

摘要

本篇報告乃運用認知治療於照顧一位重鬱症患者之護理經驗。照護期間藉由觀察、會談及運用整體性護理評估等方式收集資料，發現個案對過去、現在、未來都抱持負面的想法。個案長期受負面的認知偏差所苦，出現身體不適及強烈的自殺意念，影響其個人與家庭生活甚劇。主要健康問題為：潛在危險性自殺以及無效性因應能力。透過認知治療介入，使用「不良功能認知記錄表」練習，以正向的思考取代負向的自動化思考。結果發現：個案能修正原本曲解的認知，並提出合理的反應，情緒反應強度有顯著改善，並改善胸悶問題，且無再度出現自殺行為。返家後於電訪中，可說出駁斥自動化思考的技巧。因此建議護理人員於在職教育中，應充實認知治療理論及運用的技巧，廣泛應用於臨床。並可藉由電訪或轉介居家持續追蹤，藉此讓個案得到更完整且持續性護理，增進其生活品質，以達回歸社區目標。

關鍵字

認知治療 ； 自殺 ； 重鬱症

並列摘要

This study concerns the nursing experience of cognitive behavior therapy in taking care of a patient suffering major depression. Data collection by means of observation, interview and nursing evaluation showed the patient to be experiencing negative thoughts toward his past, present and future. He was exhibiting physical discomfort, strong suicidal ideation and impairment in personal and family functioning due to long-lasting negative thoughts. The main problems he presented were his potential suicide risk and poor coping skills. As a result of intervention with cognitive behavior therapy and the ”dysfunction cognitive scale” to facilitate the development of positive rather than negative thinking, the patient was able to adjust his inappropriate cognition and conduct himself well, with no suicidal behavior and less chest discomfort. As a result of this experience of the effectiveness of cognitive behavior therapy, we would encourage occupational education to enable nursing staff to appreciate its value in both theory and practice. Regular telephone calls and home visits can be used to enable the patient to receive complete and continual nursing care and eventually return to the community.

並列關鍵字

cognitive therapy ； suicide ； major depression