正念認知療法用於憂鬱患者之護理經驗

Nursing Experience of Applying a Mindfulness Based Cognitive Therapy on a Patient with Depression

鍾巧慧(Chiao-Hui Chung) ； 余錦星(Chin-Hsing Yu)

《長庚護理》 32卷1期 (2021/03) Pp. 135-145

https://doi.org/10.6386/CGN.202103_32(1).0012

摘要

正念認知療法是處理個案憂鬱經驗的有效策略。本案例係以正念認知療法八個階段性介入，包括：1.從自動導航，轉為有意識的生活、2.從著重思考，轉為直接感受、3.從專注過去及未來，轉為全然體驗當下、4.從逃避閃躲，轉為帶著好奇接近、5.從想讓事物變得不同，轉為接受它既有的樣子、6.從將念頭視為真實，轉視為內在的心理事件、7.從嚴厲待己，轉為仁慈悲憫的照顧好自己、8.擴展及持續正念生活，作為護理介入的治療性溝通工具，協助一位重鬱症個案改善情緒。護理期間為西元2018年4月17日至9月28日止。筆者以正念認知療法幫助個案理解到不愉快本身並非問題所在，自身如何反應不愉快的過程才是使問題持續的原因。經協助個案釐清並辨識每天生活事件的慣性回應，放下自動化情緒反應，培養心的同在模式，讓個案能夠全然地與自己的生命同在，增進生活品質，改善自身情緒，並為嶄新的生活開啟一扇大門。本文藉由介紹正念認知療法概念，輔以臨床實例的應用，可增進讀者對正念認知療法的認識，並作為護理同仁在照顧個案時另一種溝通架構之參考。

關鍵字

憂鬱症 ； 正念 ； 正念認知療法

並列摘要

Mindfulness-based cognitive therapy (MBCT) is an effective strategy for treating patients with depression. This article described the experience of caring a patient with major depressive disorder using a nursing intervention employing eight stages of MBCT as an instrument for therapeutic communication. The eight stages were as the followings: (1) changing from automatic pilot to developing awareness; (2) shifting from emphasizing thinking to directly feeling emotions; (3) developing from focusing on the past and future to experiencing the present; (4) evolving from averting problems to approaching them with curiosity; (5) shifting from wanting to change to cultivating acceptance; (6) developing from interpreting thoughts as facts to viewing them as internal psychological events; (7) evolving from demanding excessively of oneself to taking care of oneself with mercy and compassion; and (8) extending and continuing mindful living. Nursing care was provided from April 17, 2018 to September 28, 2018. Through MBCT, the author assisted the patient in understanding that displeasure was not the source of problems, but that the process of responding to the displeasure was the primary factor that made problems to persist. The nursing process assisted the patient by identifying her habitual response to everyday life events, letting go of her automatic emotional responses, developing a psychological ＂being＂ mode that facilitates the patient to be with herself completely, improving quality of life, mitigating negative emotions, and beginning a new phase in her life. By introducing the concepts of MBCT and applying them as an aid to a clinical patient, this study improved our understanding of MBCT and can serve as a reference for nursing personnel to establish a communication framework for providing patient care.

並列關鍵字

depression ； mindfulness ； mindfulness based cognitive therapy

參考文獻

古蕙瑄 (2019)．正念療癒的臨床應用．領導護理，20 (2)，17-23。[Ku, H. H.(2019). Mindfulness-based intervention in clinical settings. Leadership Nursing, 20(2), 17-23.] doi:10.29494/LN.201906_20(2).0002

許倍甄、林靜蘭、李宜燕、盧美柔 (2018)．雙相症病患接受正念認知治療之成效：系統性文獻回顧．高雄護理雜誌，35(3)，1-11。[Hsu, P. C., Lin. C. L., Lee, Y. Y., & Lu, M.J. (2018). Effectiveness of the mindfulness-based cognitive therapy for bipolar disorder: A systemic review. The Kaohsiung Journal of Nursing, 35(3), 1-11.] doi: 10.6692/KJN.201812_35(3).0001

陳寀羚、周汎澔、王秀紅 (2016)．正念之概念分析．護理雜誌，63(2)，113–119。[Chen, T. L., Chou, F. H., & Wang, H. H. (2016). Mindfulness: A concept analysis. The Journal of Nursing, 63(2), 113–119.] doi:10.6224/JN.63.2.113

潘能靜 (2015)．結合正念療法的失眠認知行為團體心理治療之案例報告─以一地區教學醫院門診的靜心好眠團體為例．臨床心理學刊，9(1)，28。[Pan, N. J. (2015). A case report of insomnia cognitive behavioral group psychotherapy combined with mindfulness therapy: A case of a meditation group in a regional teaching hospital clinic. Archives of Clinical Psychology, 9(1), 28.] doi: 10.6550/ACP.0901.018

Josefine, L. L., Malin, B., Torsten, N., & Anders, G. B. (2015). Mindfulness-based cognitive therapy: Primary care patients' experiences of outcomes in everyday life and relapse prevention. Psychology, 6(4), 464-477. doi: 10.4236/psych.2015.64044