심리적 행동주의 이론에 입각한 양극성 장애 인지 행동 치료 프로그램의 개발과 효과 = (The) development and efficacy of the cognitive behavioral therapy for bipolar disorder based on psychological behaviorism theory

국문 초록 (Abstract)

연구 1에서는 양극성 장애에 영향을 미치는 심리사회적 변인에 대한 17개의 가설을 측정하는 척도를 개발하였다. 개발된 척도를 정상군, 우울증군과 양극성 장애군에게 실시한 결과 양극성 장애와 주요 우울 장애에 공통적으로 영향을 미치는 공통 요인 12개와 양극성 장애 발병에 특정적으로 영향을 미치는 1개의 요인을 확인하였다. 공통요인으로 나타난 것은 양육시절 부모의 과대한 지각, 위험한 활동의 학습, 충동성의 강화, 성마름에의 노출, 부적 정서의 처벌, 지지 결핍, 수면 문제, 항우울제 문제, 위협에 대한 긍정 각성, 사회적 기술의 부재, 단기 쾌락 추구였으며, 특수 요인으로 나타난 것은 조증 감정 반응으로 나타났다.
연구 2에서는 연구 1의 결과를 토대로, 양극성 장애 발병의 공통 요인과 특수 요인 8개 변인을 다루는 인지행동치료 프로그램을 개발하여 치료 집단에 실시하고 그 사전 사후 측정치를 대기 집단과 비교하였다. 치료 효과를 확인한 결과 조증 감정 반응, 사회적 기술의 부재, 단기 쾌락 추구, 문제 해결 기술에 대한 개입 효과가 유의한 것으로 나타났으며 유지치료기의 전반적인 우울증상과 조증증상도 안정화되는 것으로 나타났다. 그러나 지지 결핍, 수면 문제, 항우울제 문제, 위협에 대한 긍정 각성에 대한 개입 효과는 유의하지 않은 것으로 나타났다. 끝으로 연구의 시사점과 의의 및 제한점에 대해 논의하였다.

다국어 초록 (Multilingual Abstract)

In study 1, a Bipolar I disorder etiology scale based on Psychological Behaviorism was designed and its validity and reliability were analyzed. According to the results, it has acceptable reliability and validity and it was administered to a Bipolar I disorder group, a MDD group and a Normal Control group. The results found 12 common factors influencing both MDD and Bipolar I disorder and 1 specific factors influencing only Bipolar I disorder. Common factors include the following: learning of grandiose self-labeling, learning dangerous behavior, reinforcing the impulsive behavior, exposure to irritability, punishment of negative emotion expression, lack of support, sleep problems, anti-depressant side effects problems positive arousal attitude toward threat, lack of social skills, and pursuit of short term pleasure. And specific factors include the following: manic emotional response.
In study 2, excluding past situational factors, an intervention program was administered to the Bipolar I disorder group for ameliorating 8 factors and the scale was administered both before and after the intervention. The same measuring procedure was done to the waiting list control group. The statistical analysis of group x repeated measures was applied and interaction effects were analyzed. The results indicated that manic emotional response, lack of social skills, pursuit of short-term pleasure, and lack of problem solving skills were ameliorated significantly, but lack of support, sleep problems, antidepressant side effects problems, and positive arousal attitude toward threat were not changed significantly. But the intervention significantly reduced residual depressive and manic symptoms measured by BDI and YMRS during the maintenance pharmacotherapy periods. The implications and limitations of the study were discussed and future directions of the research were suggested.

목차 (Table of Contents)

• 초록 ···································································1
• I. 서론 ·······························································2
• 1. 연구의 목적 및 필요성 ·······························2
• 2. 이론적 배경 ················································4
• (1) 양극성장애 ···············································4
• 1) 양극성장애의 진단 ··································4
• 2) 양극성장애의 원인에 관한 이론들 ·······5
• 가) 생물학적 이론 ······································5
• 나) 인지 이론 ··············································6
• (2) 심리적 행동주의에 따른 양극성장애 발병 가설 ···7
• (3) 양극성장애에 대한 인지 행동 치료 ······················16
• (4) 심리적 행동주의 모델을 검증할 때의 장점·············18
• 3. 연구 문제 ···························································19
• II. 연구 1. 양극성장애 병인론 척도의 타당화 ··20
• 1. 연구 대상 ·······················································20
• 2. 측정 도구 ·······················································21
• 3. 결과 ·······························································22
• (1) 양극성장애 병인론 척도의 신뢰도와 타당도 ··22
• (2) 양극성장애와 우울증 발병의 공통 요인과 특수 요인 ·············24
• 4. 논의 ·······························································26
• III. 연구 2. 양극성장애 치료 프로그램의 개발 및 효과 연구 ·········32
• 1. 인지 행동 치료 프로그램의 개발 ···································32
• 2. 연구 대상 ························································35
• 3. 측정 도구 ························································36
• 4. 결과 ·······························································37
• (1) 치료집단과 대기집단의 동질성 ················37
• (2) 양적 분석 결과 ·············································39
• (2) 질적 분석 결과 ·············································49
• 5. 논의 ·······························································53
• IV. 종합논의 ·······················································60
• 참고문헌 ·······························································66
• 부록 ··································································73
• 부록 1. 양극성장애 병인론 척도 ····················74
• 부록 2. 타당도 검증을 위한 시각적 아날로그 척도···81
• 부록 3. 양극성장애 인지행동 치료 집단 프로그램 ···82