運用認知行為治療照護一位持續性憂鬱症病人低自尊之護理經驗

臨床患有憂鬱症病人有逐年增加趨勢，此類病人除疾病影響外，常有慣性的負向思考基模，藉由改變其認知過程，進一步影響行為及自我評價。本文呈現一位低自尊持續性憂鬱症個案之護理經驗，筆者於照護期間2018年6月13日至2018年7月15日，藉由定期會談、陪伴、情緒支持等照護，運用關懷及同理心建立良好治療性關係，並運用直接觀察、個別會談與五大層面整體性評估，歸納整理出個案有以下問題：（1）潛在危險性自我殘害；（2）睡眠型態紊亂；（3）無效性因應能力；（4）低自尊等護理問題，筆者經與個案會談後，發現睡眠型態紊亂乃是因部隊作息、晝夜生活型態改變導致，離開部隊環境後已有改善，故針對另外三個護理問題進行討論，藉由維持治療性護病關係以提供心理衛教、心理重建、重新歸因、家庭作業、分級任務及假設實驗等認知行為治療，並加強陪伴、傾聽，使個案覺察偏差認知及自動化思考，進一步與之理性探討事件原因，修正其負向思考基模，希望能減緩個案低自尊情形並增進壓力調適技巧，以降低個案因持續性負向思考而產生的自我殘害行為。最終個案可提升自我信心及價值感並合宜地因應壓力問題。

關鍵字

持續性憂鬱症；低自尊；認知治療

並列摘要

There is an increase in the numbers of clinical depression in recent years. People who are depressed tend to have negative thoughts. The use of cognitive therapy in treating depression may improve their behavior and self-worth. This article presents a nursing experience of a patient with low self-esteem and persistent depressive disorder from June 13 to July 15, 2018. The therapeutic relationship established through regular dialogue, emotional support, and a solicitude and empathetic attitude. The process of five facts of psychiatric assessment lead to the nursing diagnoses of this patient: 1) the risk of self-harm, 2) sleep disturbance, 3) inefficient coping skills, and 4) low self-esteem. The patient's sleep disturbance resolved after he was discharged from military. Cognitive therapy used included psychological counseling, reconstruction, reattribution, homework assignment, completing hierarchical task, and discussing hypothetical experiments. The therapeutic relationship of listening and accompanying helped the patient to recognize deviations in his cognition and automatic thinking process. The patient was able to discuss the cause of incident and self-correct his negative thinking. The patient demonstrated improved self-esteem, coping skill, self-confidence, self-evaluation, and avoid self-harm behavior.

並列關鍵字

persistent depressive disorder ； low self-esteem ； cognitive therapy

參考文獻

Ayuso-Mateos, J, L., Nuevo, R., Verdes, E., Naidoo, N., & Chatterji, S, (2010). From depressive symptoms to depressive disorders: The relevance of thresholds. British Journal of Psychiatry, 196(5), 365-371. https://doi.org/365-371.10.1192/bjp.bp.109.071191

Cuijpers, P., Huibers, M., Ebert, D. D., Koole, S. L., & Andersson, G. (2013). How much psycho-therapy is needed to treat depression? A metaregression analysis. Journal of Affective Disorders, 149(1-3), 1-13. https://doi.org/10.1016/j.jad.2013.02.030

Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straren, A. (2014). The effect of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal of Affective Disorders, 159, 118-126. https://doi.org/10.1016/j.jad.2014.02.026

Furukawa, T. A., Schramm, E., Weitz, E. S., Salanti, G., Efthimiou, O., Michalak, J., Watanabe, N., Cipriani, A., Keller, M. B., Kocsis, J. H., Klein, D. N., & Cuijpers, P. (2016). Cognitive-Behavioural Analysis System of Psychotherapy (CBASP), a drug, or their combination: Differential therapeutics for persistent depressive disorder: A study protocol of an individual participant data network meta-analysis. BMJ Open. 6(5), e011769. https://doi.org/10.1136/bmjopen-2016-011769

Janssen, D. G. A., Vermetten, E., Egberts, T. C. G., & Heerdink, E. R. (2017). Prevalence of psychotropic medication use among Dutch military personnel between 2003 and 2012 and its comparison to the Dutch general population. Military Medicine, 182(1-2), e1584-e1588. https://doi.org/10.7205/MILMED-D-15-00397

主題瀏覽