運用認知行為治療照護一位強迫症患者之經驗

A Nursing Experience of Applying Cognitive-Behavioral Therapy to the patient With Obsessive-Compulsive Disorder

林家麗(Jia-Li Lin) ； 李柏鋆(Po-Yun Li) ； 陳詩庭(Shih-Ting Chen) ； 洪昭安(Chao-An Hung)

《精神衛生護理雜誌》 14卷2期 (2019/12) Pp. 40-49

https://doi.org/10.6847/TJPMHN.201912_14(2).04

摘要

本文個案長期受強迫症狀干擾，嚴重影響日常生活、社交、工作及自我照顧能力而導致自尊低落、負向思考及無望感，故運用認知行為治療協助改善症狀之護理經驗。照護期間為2017年10月30日至2017年12月6日，藉由直接照護、會談、病歷回溯，運用五大層面評估，歸納主要護理問題為：無效性因應能力、焦慮、長期性低自尊。過程中以尊重、同理的態度建立治療性關係，與醫療團隊合作，訂定行為契約以增進自我照顧及合宜的因應能力，運用暴露／不反應的行為治療減少強迫行為頻率或時間，及以蘇格拉底式問話，協助找出強迫行為背後之非理性想法，並修正原有的思考模式，透過鼓勵找尋目標及促進人際互動等方式建立正向的自我感受，個案強迫症狀及焦慮情緒減少且能與症狀和平共存，將重要他人之期待轉化為成長動能，學習自我肯定。建議可盡早鼓勵家人一同參與執行認知行為治療，以達到最佳之療效。

關鍵字

強迫症 ； 認知行為治療 ； 護理

並列摘要

The patient in our study having been affected by obsessive-compulsive symptoms for a long time proved that the symptoms would dramatically affect his quality of life, for instance, social work, and the ability of self-caring. In our conclusion, obsessive-compulsive symptoms can lead to low self-esteem, negative thinking, and hopelessness. Therefore, according to our past nursing experience, we utilized cognitive behavioral therapy to help the patient adapt to his negative symptoms. Our caring plan which launched from October 30, 2017, to December 6, 2017, was through direct care, interviews, chart review, and psychiatric five-dimensional global assessment to summarize several main health issues which included individual ineffective coping skill, anxiety, long-term low self-esteem. In order to establish therapeutic relationships in a respectful and empathic process way, we applied exposure/non-responsive behavioral therapy to reduce the frequency of compulsive behavior. Furthermore, by doing the Socratic question to help the patient identify irrational thoughts behind compulsive behavior and to adjust the original thinking pattern. Being cooperative with the medical team after a period of time, the patient enhanced self-care ability through establishing behavioral contracts, built up positive sense and regained self-esteem by injecting hope and searching goals. Afterward, the patient could peacefully coexist with OCD and turned important others' expectations into his momentum. We strongly recommend that all family members should participate in cognitive-behavioral therapy as early as possible for the best outcome of treating Obsessive-Compulsive Disorder.

並列關鍵字

obsessive-compulsive disorder ； cognitive-behavioral therapy ； nursing experience

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