폭식행동자를 위한 인지행동 집단치료의 도중탈락 예측요인

공성숙 ( Seong Suk Kong ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2000 정신간호학회지 Vol.9 No.3

본 연구는 폭식행동자들을 대상으로 인지행동 집단치료를 시행하였을 때 치료를 종결하지 못하고 도중탈락하는 대상자들을 예측하는 요인들을 알아보기 위해 수행되었다. 치료를 종결한 폭식행동자들과 도중탈락한 대상자들의 특성을 비교한 결과 폭식빈도가 두 집단간에 가장 유의한 차이를 보였다. Blouin 등(1994)은 69명의 폭식증 환자들을 대상으로 인지행동 집단치료를 시행하고 치료의 예측인자를 조사한 결과 폭식빈도와 EDI의 점수가 높은 환자일수록 치료 후 폭식빈도의 감소율이 더 높은 것으로 나타났는데, 이는 증상이 심한 환자일수록 치료에 대한 동기가 높기 때문이거나 혹은 증상이 심한 환자는 폭식빈도가 크게 감소하지만 증상이 약한 사람은 그 낮은 빈도를 줄이기가 더욱 어렵기 때문일 수도 있다고 설명했다. 그러나 Bulick 등(1999)이 인지행동치료에 대해 효과를 나타내는 ‘반응자’와 거의 효과가 없는 ‘무반응자’의 차이를 연구한 결과에서는 반응자들이 무반응자에 비해 치료 전부터 폭식이나 구토 횟수가 유의하게 낮은 것으로 보고했으며, Coker 등(1993)은 치료를 지속하지 못한 환자 집단과 치료를 지속한 환자 집단간에 폭식빈도에는 유의한 차이가 없는 것으로 나타났다. Waller(1997)의 연구에서도 도중탈락자와 치료종결자 사이에는 폭식빈도에 유의한 차이가 없는 것으로 나타나 본 연구와는 상반된 결과를 보이고 있다. 이러한 불일치된 연구결과는 향후 지속적인 반복연구의 필요성을 제시하고 있다. 또한 폭식빈도와 마찬가지로 식이행위의 범주에 속하는 구토빈도는 두 집단간에 유의한 차이가 없는 것으로 나타났는데, 이는 폭식행동자 가운데 ‘하제 비사용형(non-purge type)``에 속하는 대상자들의 경우 폭식삽화만 반복될 뿐 구토나 하제, 이뇨제 사용 등의 보상행동이 나타나지 않기 때문이다. 따라서 두 집단 내에 ’하제 비사용형‘ 대상자의 비율을 통제해야만 구토빈도가 의미있는 변수가 될 것이다. 본 연구에서는 전체 대상자의 수가 많지 않아 이 변수를 통제하지 못한 제한점을 가지고 있다. EDI(다차원적 섭식태도) 도구의 11개 하부척도로 측정한 식이태도 변인 중에서는 대인관계 불신감만이 두 집단간에 유의한 차이가 있는 것으로 나타났다. Blouin 등(1995)의 연구에서는 치료를 종결까지 유지한 환자들의 요인을 판별분석한 결과 대인관계상의 어려움 (interpersonal difficulties)만이 유일한 예측변인으로 나타나 본 연구와 일치된 결과를 보고하였다. 즉, 집단 내에서 다른 구성원에 대한 신뢰감이 떨어지고 대인관계를 잘 맺지 못하는 대상자의 경우 더 쉽게 도중탈락을 보인다는 것이다. 따라서 연구자는 인지행동 치료가 집단치료의 형태로 시행되는 경우 도중탈락율을 줄이기 위해서는 집단내의 ‘집단과정(group process)``과 ‘집단의 응집성(cohesiveness)``이 매우 중요하다고 역설하였다. 또한 이와 같이 대인관계에서 신뢰감이 적은 성격적 요인을 가진 대상자의 경우 집단치료보다는 인지행동 개인 치료에서 치료효과가 더 높은 경향을 보인다고 하였다. 치료전 증상이 지속되어온 유병기간은 치료를 종결한 집단이 도중탈락자 집단보다 더 긴 것으로 나타났다. 이러한 결과는 폭식빈도, 즉 증상의 정도가 심한 환자의 경우 도중탈락율이 적은 것으로 나타난 것과 같은 맥락으로 볼 수 있다. 즉, 증상이 지속된 기간이 길 경우 증상의 정도도 더 심하며 이러한 대상자들은 치료에 대해 동기가 더 높은 것으로 생각된다. 또한 Turnbull 등(1997)은 16주의 인지행동치료와 8주의 자조 프로그램의 치료효과 예측요인을 비교한 결과, 치료전 질병이 지속된 기간이 길수록, 폭식빈도가 적을수록 치료효과가 높다고 보고하여 본 연구의 결과를 지지하였다. Turnbull 등(1997)도 역시 유병기간이 긴 대상자일수록 치료나 회복을 향한 단계를 수행할 준비가 더 잘 되어있기 때문이라고 설명하고 있다. 이와 반대로 유병기간이 짧거나 증상의 정도가 약한 대상자의 경우 증상으로 인한 고통보다는 체중감량에 대한 열망이 더 높기 때문에, 인지행동치료에서 폭식을 유발하는 근원이 되는 다이어트를 중지해야 한다는 중재를 수용하지 못하고 도중탈락하는 경향이 높은 것을 볼 수 있었다. 본 연구에서는 기존의 연구들과는 달리, 신체불만족이나 우울, 자아존중감 변인들은 도중탈락에 영향을 미치지 않는 것으로 나타났다. 이러한 불일치된 결과는 기존의 연구들과 방법론적인 차이점이 많고 치료 및 대상자의 특성에 따른 차이점에 기인한다고 본다. 본 연구에서 뿐 아니라 기존의 연구에서도 대상자의 수가 충분하지 않기 때문에 표본의 대표성이 낮기 때문이다. 향후 폭식 행동자를 대상으로 인지행동 집단치료를 실시하면서 반복적인 연구를 시행하는 것이 중요하다고 하겠다. 또한 개인 인지행동 치료를 받는 집단과의 비교연구가 실행된다면 그 결과가 더욱 명확해질 것이라고 본다. 이상의 연구결과에서 알 수 있듯이 폭식행동자를 대상으로 인지행동 집단치료를 실시했을 때, 도중탈락자에 비해 치료종결자는 높은 폭식빈도와 긴 유병기간, 낮은 대인관계 불신감을 갖고 있으므로, 도중탈락율을 줄이기 위해서는 대상자를 선정할 때 이러한 요인들을 먼저 고려해야 할 것으로 생각된다. 즉, 대인관계 불신감이 높은 대상자에게는 개인 인지행동치료나 개인정신치료를 권장하고, 폭식빈도나 유병기간이 짧은 대상자에게는 다이어트 중지에 대한 권고를 완화시키고 건강한 다이어트 방법을 교육하는 등 중재 접근방법에 수정이 요구된다고 하겠다. Background and purpose : Cognitivebehavioral grouptherapy has become the most popular form of treatment for binge eaters, as it has been demonstrated to be a highly cost-effective method of treating bulimic patients. Unfortunately drop-out rate from group CBT is relatively high. The purpose of this study was to identify predictors of drop-out from cognitive-behavioral group therapy for binge eaters. Prior to treatment, all subjects completed the EDI-2(Eating Disorders Inventory-2), the Rosenberg`s Self-Esteem Scale, the BDI(Beck Depression Inventory), and interviewed the binge and purge frequency per week. In this study, among 41 binge eaters who participated 10-week cognitive-behavioral group therapy, drop-out rate was 36.6%(15 binge eaters). Binge eaters were all women and mean ages of them were 24 years and 95.1% of them were unmarried. 75.6% of them were bulimia nervosa, and the remainders were anorexia nervosa and binge eating disorders. To examine the predictors of drop-out, discriminant analysis was used. The completers were significantly higher in binge frequency and were lower in interpersonal distrust than drop-outs, and in duration of illness the completers also tended to be longer but these univariate differences didn`t reach statistical significance. Wilk`s Lamda was .776 indicating that differences between the completers and drop-outs were significant. The discriminant function analysis was able to successfully predict drop-outs and completers of treatment in 73.2% of cases. Predicted dropouts were correctly identified in 86.7% of cases whereas predicted completers were correctly identified in 65.4% of cases. In conclusion, binge frequency, interpersonal distrust, and duration of illness predicted drop-out from cognitive-behavioral grouptherapy for binge eaters. This results would enable clinicians to more effectively utilize pretreatment assessment information in planning treatment for binge eaters. If patients at risk for dropping out group CBT can be identified at assessment, they may be referred instead to individual CBT, where the likelihood of dropping out is lower. Further research with the larger sample size, and included family factors and personality variables was suggested.

해병대 병사들의 아동기의 심리적 외상경험과 사회적 지지가 해리증상에 미치는 영향

공성숙 ( Seong Sook Kong ),김혜림 ( Hey Rim Kim ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2015 정신간호학회지 Vol.24 No.4

Purpose: The purposes of the study were to investigate childhood traumatic experiences and social support that might influence dissociative symptoms in Marine soldiers. Methods: A cross-sectional study design was used with participants who were soldiers (n=122) assigned to one Marine corps in Ganghwa Island in the study. Data were collected on September 2015 through self-report using the Childhood Trauma Questionnaire, Social Provisions Scale (SPS), and Dissociative Experience Scale. Descriptive analysis, t-test, ANOVA, Pearson``s correlation coefficients and stepwise multiple regression were performed. Results: A total of 11.5% self-reported experiencing over three types of trauma; emotional neglect 34.4%, physical neglect 32.8%, emotional abuse 11.5%, physical abuse 11.5%, and sexual abuse 9.8%. For all subscales of the SPS, means of item were as high as three out of four points. A total of 9.0% were likely to be dissociative disorder. Sexual abuse, attachment, and opportunity for nurturance were found to be significant factors influencing dissociative symptoms. Conclusion: Future military enlistment in Marines should include assessment of childhood trauma and dissociation to identify maladaptive soldiers. Because soldiers who experienced childhood sexual abuse are likely to show dissociative symptoms, military nurses should assess their social support and try to enhance attachment in order to prevent dissociative symptoms.

여성 섭식장애 환자의 다중충동성 관련요인

공성숙 ( Seong Sook Kong ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2012 정신간호학회지 Vol.21 No.2

Purpose: The purpose of the study was to investigate the factors that affect multi-impulsivity in women patients with eating disorders. Methods: The participants in the study were 170 women patients with eating disorders who visited "M" clinic for eating disorders. Data were collected from January 2010 to February 2011 through semi-structured interviews and self-report using the Revised Diagnostic Interview for Borderlines, Eating Disorders Inventory-2, and The Childhood Trauma Questionnaire. Data were analyzed using x2-test, t-test, and multiple logistic regression. Results: The multi-impulsivity group accounted for 56.5% of the patients (binge eating 90.6%, alcohol abuse 43.5%, substance abuse 37.1%, sexual promiscuity 4.7%, suicidal attempts 38.8%, and self-mutilation 58.8%), and they showed higher scores on childhood trauma and eating psychopathology than a comparison group. Significant predictors for multi-impulsivity were emotional abuse, social insecurity, interoceptive awareness, and interpersonal distrust. Conclusion: The results of this study suggest future interventions for multi-impulsive patients with eating disorders should focus on solving interpersonal problems by establishing trustful relationships, and not focus on eating behavior early in treatment.

섭식장애 환자의 아동기 외상경험이 자해행동에 미치는 영향과 부모 간 갈등의 매개효과 분석

공성숙(Seong Sook Kong),이정현(Jung Hyun Lee),신미연(Mi Yeon Shin) 한국간호과학회 정신간호학회 2009 정신간호학회지 Vol.18 No.1

섭식장애 환자의 알코올 문제 관련요인 분석

공성숙 ( Seong Sook Kong ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2011 정신간호학회지 Vol.20 No.2

Purpose: The purpose of the study was to investigate the psychological factors such as eating psychopathology, depression, obsessive-compulsion, sleep problem, and stressors that affect the alcohol problems in patients with eating disorders. Methods: Patients with eating disorders (n=347) who visited "M" clinic for eating disorder were participated in the study. Data were collected from February 2008 to May 2010 using Eating Disorder Inventory-2, Beck Depression Inventory, Maudsley Obsessional-Compulsive Inventory, and Alcohol Use Disorder Identification Test-Korean. Results: Of the participants, 17.3% had an alcohol problem, 9.2% of them were diagnosed with alcohol dependency. Age, history of mental disorder in family, stress for love relationship, difficulties falling asleep, and ``impulse regulation`` (one of eating psychopathologies) were significant associated factors of alcohol problem, but depression and obsessive-compulsion were not significant. Conclusion: Future interventions for patients with eating disorders should focus on assessing alcohol problems. Assessment should be non-judgmental, especially for those patients with high levels of impulse dysregulation, difficulties falling asleep, and stress in love relationship in order to prevent their early drop-out for the treatment. Alternative treatment for sleep problem and stress management also may be helpful for the patients with alcohol problem and eating disorders.

아동기의 심리적 외상경험과 외상 후 스트레스 증상 및 해리와의 관계에서 집단 따돌림의 매개효과

공성숙 ( Seong Sook Kong ),배재현 ( Jae Hyun Bae ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2013 정신간호학회지 Vol.22 No.3

Purpose: The purposes of the study were to determine whether specific forms of childhood traumatic experience predicts post traumatic stress symptoms and dissociation and to investigate the mediating effects of bullying experience on forms of childhood trauma and post traumatic stress symptoms or dissociation. Methods: Participants were patients (n=90) from "S" clinic for psychological trauma. Data were collected from January 2012 to January 2013 through semi-structured interviews and self-reports using a modified Lifetime Incidence of Traumatic Events, Korean Version of Impact of Event Scale-Revised, and Dissociative Experience Scale. Results: The participants showed high rates for childhood trauma and high scores on post traumatic stress symptoms and dissociation, and 38.9% of participants self-reported experiencing more than three types of trauma. Physical abuse was found to be a significant predictor of post traumatic stress symptoms and dissociation. It was also found that bullying experience partially mediated the association between physical abuse and post traumatic stress symptoms or dissociation. Conclusion: Future interventions for patients with childhood trauma should focus on assessing the possibility of dissociation. As boys and girls who experienced physical abuse in childhood are likely to be victims of bullying, school counselors should assess their support system and refer to mental health professionals as necessary.

심리적 외상경험자의 해리 관련요인에 대한 판별분석

공성숙 ( Seong Sook Kong ),배재현 ( Jae Hyun Bae ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2014 정신간호학회지 Vol.23 No.3

Purpose: The purpose of the study was to identify the discriminating power of dissociation as defined by depression, obsession, and Minnesota Multiphasic Personality Inventory(MMPI; psychopathology) in patients with psychological trauma. Methods: Participants were patients (N=114) from "S" clinic for psychological trauma. Data were collected from April to June 2014 through semi-structured interviews and self-reports using a modified Lifetime Incidence of Traumatic Events, Dissociative Experience Scale (DES), Beck Depression Inventory-2, Maudsley Obsessional Compulsive Inventory, and MMPI-2. Results: Participants were grouped in to two groups depending on DES scores; dissociative (n=15) and non-dissociative (n=99). Depression, F-scale (infrequency), Ma (Hypomania), and Hs (Hypochondriasis) scale of MMPI correctly discriminated 86.8% of the sample. There were also significant differences in Obsession, K-scale (korrection), D (Depression), Hy (Hysteria), Pd (Psychopathic Deviate), Pa (Paranoia), Pt (Psychasthenia), Sc (Schizophrenia), Si (Social Introversion) scales of MMPI between two groups, but they were not significant discriminant factors. Conclusion: Future interventions for patients with high levels of dissociation and psychological trauma should focus on the prevention of suicide and chronic dissociation by assessing depression-related factors; suicidal behavior, impulsivity, aggression, and alexithymia. Therapists should also interpret patients’ MMPI profiles carefully, especially in the presence of an extremely elevated F-scale.

일반 부부와 부부클리닉 방문부부의 결혼만족도에 영향을 미치는 요인

공성숙 ( Seong Suk Kong ) 한국정신간호학회 2006 정신간호학회지 Vol.15 No.4

입원한 정신질환자 가족의 가정간호 요구도와 가족부담감

김소야자,현명선,성경미,공성숙,Kim, So-Ya-Ja,Hyun, Hyung-Sun,Sung, Kung-Mi,Kong, Seong-Suk 대한간호협회 1993 대한간호 Vol.32 No.3

This study was designed to investigate the family burden, family home care needs and to identify the relationship between family burden and home care needs for families of psychiatric in-patients. The subjects for this study were 104 family members of psychiatric in-patients at two private hospitals and one municipal hospital. The data were collected during the period from February 1. 1993 to March 30. 1993. The questionnaire developed by Montgomery to measure the family burden was used as modified by the research team for this study. The questionnaire was developed by Garrad to measure the home care need was also used as modifed by the research team. The data was analyzed using descriptive statistics, t-test, ANOV A and Pearson Correlation Coeffcient. with the SPSS program. The Result of this study can be summarized as follows ; 1. For perceived family burden, the meanscore as measured by the guestionnaire was 70.6 of a possible to total of 110. 2. For home care need. the meanscore as measured by the questionnaire was 44.8 fo a possible total of 66. 3. The results showed a higher score for cases from the municipal hospital for family burden and a higher score for cases at the private hospitals for home care need. 4. Ther was a statistically significantly higher score on family burden for female family member (T =-2.77. P<.05) and for bereaved family members. (F=2.862. p<.05) 5. There was a statistically significantly higher score (F= 10.3535, P<.001) for family burden when the hospitalization period was between 7~ 12 months and a statistically significantly higher score (F =7.679.P<.001) for home care need when the hospitalization period was over 37 months. 6. Ther was a significant correlation between family burden and home care need. (r=.4002, P<.05) The conclusion that can be drawn from this study is that addressing home care needs would contribute to reduce family burden.

섭식장애 가족에 대한 개입

김준기(Kim Joon Ki),공성숙(Kong Sung Sook) 한국가족치료학회 2001 가족과 가족치료 Vol.9 No.2

섭식장애는 사회·문화적인 요인과 더불어 가족적인 요인에 의해서 많은 영향을 받는다는 점에서 가족치료가 중요한 개입방법의 하나가 될 수 있다. 본 연구에서는 섭식장애 환자의 가족치료에 대한 이론적 모형, 특히 Minuchin의 구조적 가족치료와 Maudsley 모델을 근간으로 이론적 배경과 치료 접근방법을 고찰하고 임상사례의 분석을 통하여 그 치료기법을 적용하는 과정과 효과를 알아보았다. Minuchin의 모델에서는 밀착, 과잉보호, 경직성, 갈등회피, 갈등우회에 대한 개입을 중시한다. 반면, Maudsley 모델에서는 초기에 부모로 하여금 환자의 식행동에 개입하게 함으로써 증상을 감소시킨 후, 새로운 관계유형을 만들어서, 청소년기의 문제를 다룬 후에 종결을 한다. 본 연구의 결과를 통하여 형제관계를 다루는 session을 포함하는 것과 매우 지쳐 있는 상태에서 병원을 방문하게 되는 환자의 부모에게 힘을 불어넣고 치료동기를 증진시키기 위한 자조집단의 구성 등을 제언하였다. Family Therapy is an important intervention tool for families of eating disorder when it is greatly affected by familial factors as well as social and cultural factors. This study looked into Minuchin s structural family therapy and Maudsley s multifactorial model as theoretical foundations for an intervention to a family with an eating disorder client. In Minuchin s model, intervention to enmeshment, over protection, rigidity, conflict avoidance, and conflict detour is emphasized. In Maudsley s medel, on the other hand, the intervention is started with refeeding the patient. Negotiation for a new pattern of relationship and dealing with problems of adolescent stage take place after the initial stage. Authors suggest 1. therapy sessions that deals with sibling issues; and 2. support groups for the burned-out parents in order to empower them and enhance their motivation for the treatment of their children .