정신건강전문요원으로서의 임상심리학자의 현재와 미래

원성두,최선,배금예,배대석,이준석 한국임상심리학회 2018 Korean Journal of Clinical Psychology Vol.37 No.S

1995년 정신보건법의 제정으로 국내 임상심리학자는 국가가 발급하는 전문자격증을 취득해 국가 정신건강 사업에 참여할 수 있는 법적 지위를 얻게 되었다. 이를 통해서 임상심리학자가 정신건강전문요원 중 하나로 자리매김하게 되면서 전문가로서 진출할 수 있는 영역 및 활동범위가 확대되었다. 2016년 정신보건법이 [정신건강증진 및 정신질환자 복지서비스 지원에 관한 법률]로 전면 개정됨에 따라 정신건강임상심리사의 역할이 다양해지고 이에 맞게 수련과정이 개편되었으며 자격 취득 후의 보수교육이 의무화되었다. 국내 정신건강임상심리사 제도의 역사, 주요 업무, 배출 현황 및 수련 실태를 살펴보고 향후 발전방향을 논의하였다. 특히 정신건강 시스템의 변화로 인해 발생한 현안문제들을 고려할 때 정신건강임상심리사가 국가 전문자격증으로서 법적 지위를 지속적으로 보장받는 데 필요한 대안을 제시하였다.

목표중심 자기조절이 알코올 사용 문제에 미치는 영향: 우울의 매개효과

원성두,김수룡 한국임상심리학회 2017 Korean Journal of Clinical Psychology Vol.36 No.3

A wide range of addictions is conceptualized as a chronic failure of self-regulation. Accordingly, the present study aimed to confirm the relationships among goal-focused self-regulation, depressive symptoms, and alcohol use problem, which is a common addictive behavior. A total of 470 adults were recruited from metropolitan cities in South Korea. All participants completed a questionnaire that included the Korean Version of the Alcohol Use Disorders Identification Test (AUDIT-K), Goal-Focused Self-Regulation Scale (GF-SRS), and Patient Health Qustionnaire-9 (PHQ-9). A correlation analysis revealed that goal-focused self-regulation was negatively correlated with both depressive symptoms and harmful alcohol use, while depressive symptoms were positively correlated with alcohol use problems. A structural equation modeling (SEM) revealed that a full mediation model had a better fit than a partial mediation model did. Additionally, the indirect effect was significant. In sum, these results suggest that goal-focused self-regulation might decrease depressive symptoms, which in turn would decrease the severity of the alcohol use problem. In line with these results, clinical implications and limitations of this study were discussed.

목표중심 자기조절 척도의 개발 및 타당화

원성두,오송인,박선희,이민규 한국건강심리학회 2015 한국심리학회지 건강 Vol.20 No.4

In recent years, there has been growing interest in self-regulation as a major predictive factor of addictive behaviors, including alcohol use problems, smoking, impulsive and compulsive buying, and mood disorders such as major depressive disorder and anxiety disorders. Responding to this interest and need, we created the Goal-Focused Self-Regulation Scale (GF-SRS), a self-report instrument. For the purpose of this study, self-regulation was defined broadly, incorporating concepts of goal orientation and the implementation thereof, emotion regulation, and positive thinking. A cross-validation study was conducted on the GF-SRS using university students and non-clinical samples. In the study 1, preliminary questions were selected based on the operational definition of self-regulation followed by an exploratory factor analysis, which was conducted on a sample of university students. The results confirmed four underlying factors of the 13-item GF-SRS: goal orientation, goal implementation, positive thinking, and emotional regulation. Furthermore, the results generally showed internal consistency, ranging from .76 to .88. Self-regulation was observed to converge with self-control and executive functioning and diverge from emotional suppression and social desirability. In study 2, a confirmatory factor analysis was conducted on a sample of 275 university students and 272 adults. According to the results, the four-factor model of the GF-SRS had the best fit compared to other competing models. A criterion-related validation study was also conducted to evaluate the incremental validity of self-regulation. Self-regulation demonstrated a 22% overall incremental relationship with mental health after controlling for depression. Lastly, the study discusses the clinical utility and limitations of the GF-SRS. 최근 알코올이나 니코틴 등의 약물에 대한 의존에서 충동 및 강박 소비에 이르기까지 다양한 중독행동뿐만 아니라 주요우울장애, 불안장애 등 정서장애의 주요 예측변인으로서 자기조절(self-regulation)에 대한 관심이 증가하고 있다. 본 연구에서는 자기조절을 목표 지향 및 실행, 정서조절, 긍정적 사고를 포함하는 광의의 개념으로 정의하고 목표중심 자기조절 척도(Goal-Focused Self-Regulation Scale: GF-SRS)를 개발해 대학생 및 일반인 표본에서 교차 타당화하고자 하였다. 연구 1에서는 연구자의 자기조절에 대한 조작적 정의에 기초해 GF-SRS의 예비문항을 선정하고대학생 표본에서 수집된 자료에 대해 탐색적 요인분석을 실시한 결과 13문항의 GF-SRS가 목표지향, 긍정적 사고, 정서조절, 목표실행 등 4요인으로 구성되는 것을 확인하였다. 또한 내적 합치도가전체 문항은 .85, 목표지향은 .83, 긍정적 사고는 .88, 정서조절은 .85, 목표실행은 .76으로 대체로 양호한 신뢰도를 나타냈다. 또한 자기통제력, 집행기능과는 수렴되었고, 정서억제 및 사회적 바람직성과는 변별되는 것으로 나타났다. 연구 2에서는 대학생 및 일반인 성인 남녀 표본에서 확인적 요인분석을 실시한 결과 다른 모형에 비해 GF-SRS의 4요인 모형의 적합도가 가장 우수하였다. 아울러정신건강을 종속변수로 설정하고 GF-SRS의 준거관련 타당도를 확인한 결과, 우울을 통제하고도22%의 추가적인 설명량을 나타냈으며, 3가지 정신건강 하위 요인에 대해서도 유의한 추가적인 설명량을 보였다. 끝으로 GF-SRS의 제한점과 임상적 유용성에 대해 논의하였다.

한국형 긍정적 행동지원 3차 실행충실도 척도(KT3-FC)의 개발과 타당화

원성두,장은진,조광순,송원영,남동미 한국심리학회산하학교심리학회 2020 한국심리학회지 학교 Vol.17 No.2

As a tiered system of supports, School-Wide Positive Behavior Support (SWPBS) is an evidence-based practice in the educational system of Korea. An important aspect of SWPBS is the ongoing progress monitoring and evaluation of implementation fidelity. This study aimed to develop and validate the Korean Tier 3 School-Wide Positive Behavior Support Implementation Fidelity Checklist (KT3-FC). The preliminary KT3-FC consisted of a 37-item, 6-factor checklist. In the first phase of the study, 10 experts reported that the range of content validity of the KT3-FC was adequate. In the second phase of the study, 185 teachers (52 men and 133 women) who implemented SWPBS completed the KT3-FC, Individualized Supports Questionnaire, School Climate Questionnaire, School Discipline Practice Scale, and PBS Effectiveness Scale. An exploratory factor analysis resulted in a 5-factor structure, with 20 items, instead of 37 items, consisting of: (a) progress monitoring and evaluation of the individualized supports, (b) provision of supports by aligning and integrating mental health and SWPBS, (c) crisis management planning, (d) problem behavior assessment, and (e) establishment of individualized support team. The internal consistency of the KT3-FC was good (full scale α = .950, sub-factor α = .888 ~ .954). In addition, the KT3-FC showed good convergent validity, having statistically significant correlations with the Individualized Support Questionnaire, School Climate Questionnaire, School Discipline Practice Scale, and the PBS Effectiveness Scale. Finally, the confirmatory factor analysis showed that the 5-factor model of the KT3-FC had some good model fits, indicating that the newly developed fidelity measure could be a reliable and valid tool to assess the implementation of Tier 3 supports in Korean schools. Accordingly, the KT3-FC could contribute to implement SWPBS as an evidence-based behavioral intervention for Korean students. 본 연구의 목적은 다층적 행동지원 모형을 적용하고 있는 학교차원 긍정적 행동지원(School-Wide Positive Behavior Supports, SWPBS)을 국내 학교현장에서 근거기반 실천으로 보급하기 위해 개별화지원에 해당하는 3차 지원의 실행충실도 평가도구를 개발해 타당화하는 것이었다. 3차 지원 실행충실도 평가도구를 개발하기 위해 문헌 개관 및 전문가 내용 타당도 검증을 통해 핵심 평가요소 6개 요인으로 구성된 37개의 예비문항을 선정하였다. 이후 학교차원 긍정적 행동지원 실행 경험이 있는 현직 교사 185명(남 52명, 여 133명)을 대상으로 3차 지원 실행충실도 척도, 개별화지원 척도, 학교풍토 척도, 학생지도 척도, 긍정적 행동지원 효과성 척도로 구성된 설문지를 배포해 자료를 수집하였다. 탐색적 요인분석에서 각 하위요인에 4문항으로 구성된 5요인 구조(요인 1: 개별화지원 계획의 점검 및 평가, 요인 2: 정신건강 서비스 연계를 통한 지원, 요인 3: 위기관리 계획, 요인 4: 문제행동 평가, 요인 5: 개별화지원 팀 구성)의 총 20문항이 최종 문항으로 선정되었다. 또한 내적 합치도는 전체 문항 α=.950, 하위요인은 α=.888 ~ .954로 모두 양호하였다. 상관분석에서 3차 지원 실행충실도 척도는 개별화지원 척도, 학교풍토 척도, 학생지도 척도, 긍정적 행동지원 효과성 척도와 각각 유의미한 상관을 나타내면서 양호한 수렴타당도를 나타내었다. 마지막으로, 확인적 요인분석에서 5요인 구조의 모형 적합도는 양호하였고, 신뢰도 및 타당도가 안정적인 것으로 나타났다. 따라서 SWPBS의 실행충실도를 점검하고 평가하는 데 본 척도가 신뢰롭고 타당하게 사용될 수 있을 것으로 보인다. 또한 한국형 3차 지원 실행충실도 척도가 국내 학교현장에서 SWPBS를 근거기반의 행동적 개입으로 활용하는 데 기여할 수 있을 것이다.

자기조절 연구 현황 및 발전 방향

원성두,김임렬,이민규 한국심리학회 2015 한국심리학회지 일반 Vol.34 No.1

Self-regulation is considered as a key factor in behavioral problems and mental health. However, the concept of self-regulation is still subtle, and there are so different definitions and models in a variety of literature in psychology, including clinical psychology. To our knowledge, there is a lack of systematic researches in relation to self-regulation in Korea. We provided an overview of the status of self-regulation research, including major theories, measurement tools and psychological intervention methods. Moreover, we suggested that development of goal-focused self-regulation programme might be needed for enhancement of mental health in general populations as well as patients with clinical disorders. 자기조절(self-regulation)은 행동 문제 및 정신건강의 주요 변인인 것으로 알려져 있다. 하지만 개념 자체가 여전히 모호하며, 임상심리학을 비롯해 심리학 내 여러 분야에서 상이한 개념 및 모델이 존재한다. 우리가 아는 바로는 국내에서 자기조절에 대한 체계적인 개관이 부족한 실정이다. 본 개관에서는 자기조절과 관련해 심리학 내의 각 분야를 대표하는 주요 이론들, 측정도구 그리고 심리적 개입법을 살펴보았다. 아울러, 임상적인 수준의 장애를 가진 환자들뿐만 아니라 일반인들의 정신건강 증진을 위한 목표-중심 자기조절 프로그램 개발의 필요성을 제안하였다.

대한민국 심리서비스 관련 법령 및 적용 현황, 향후 방향성 모색

원성두,장은진 한국심리학회 2022 한국심리학회지 일반 Vol.41 No.3

The aim of this study is to systematically analyze the status of psychological services such as legislation, qualification system, and provision of psychological services for public mental health, and to suggest future directions for psychological services to improve the national level of mental health. For this, 78 existing laws were found and analyzed using “psychology” and “psychological counseling” as key words on the Korean Law Information Center website. As a result, there was no distinct law solely discussing the psychological services. In particular, only the Improvement of Mental Health and the Support for Welfare Services for Mental Patients (in short, Mental Health Welfare Act) defines the qualifications and scope of work of mental health psychologists, one of the mental health specialists. However, this law has a limited scope of psychological services that could be offered and tends to be limited to those with mental illness. For licenses offered by governments for qualifications, there are mental health clinical psychologist, licensed by the Ministry of Health and Welfare, and clinical psychologist licensed by the Human Resources Development Service of Korea, but the difference in quality of expertise between these two is remarkable. In addition, it is difficult for the general public to identify a reliable service provider because of prevalence of inappropriate licenses issued by unqualified private service providers. In terms of public psychological services, the health and welfare sector lacks a delivery system in comparison to the demand for psychological services, while psychological professionals are proactively employed by various other field such as Ministry of National Justice, Ministry of National Defense, and local governments. Therefore, it can be stated that an independent legislation specifying the provision of psychological services and establishment of a license for global-standard psychologist is necessary. This legislation is expected to contribute significantly to the expansion of community-based psychological services. In particular it will improve the public access to psychological services, thereby advancing the people's mental health and quality of life. 본 연구는 심리서비스 관련 법령, 심리사 자격제도, 공공 정신건강 심리서비스 제공 등 대한민국의 심리서비스 현황을 분석해 국민 정신건강 증진을 위한 심리서비스의 향후 방향성을 모색하고자 하였다. 이를 위해 국가법령정보센터에서 ‘심리’ 또는 ‘심리상담’의 키워드로 심리서비스 관련 78개 법령을 분석하였다. 그 결과, 국내에는 심리서비스 관련 독립적인 법률이 마련되어 있지 않았다. 특히 정신건강증진 및 정신질환자 복지서비스 지원에 관한 법률만이 정신건강전문요원 중 하나인 정신건강임상심리사의 자격기준과 업무 범위를 명시하고 있으나 이마저도 심리서비스의 범위가 제한적인 데다 적용 대상 또한 대부분 정신질환자로 제한하는 경향이 있다. 국가자격증으로 보건복지부 발급 정신건강임상심리사와 산업인력공단 발급 임상심리사가 있으나 전문성의 질적 차이가 현저하다. 한편, 심리서비스 제공인력으로서 부적격한 민간 자격증의 난립으로 인해 일반인이 효과성을 신뢰할만한 서비스 제공자를 판별하기 어려운 실정이다. 공공 심리서비스 측면에서 보건복지 영역은 심리서비스 수요에 비해 전달체계가 부족한 데 반해, 보건복지 영역 이외의 법무 및 사법체계, 경찰, 국방부, 병무청, 지방자치단체 등 다양한 영역에서 전문심리 인력을 적극적으로 활용하고 있다. 따라서 심리서비스 관련 법률 제정 및 국제 수준의 국가전문자격심리사 제도 도입이 시급하다. 국가전문자격심리사 제도는 지역사회 기반 정신건강 사업의 확대, 특히 국민의 심리서비스 접근성 향상에 크게 기여하여 국민의 정신건강 및 삶의 질을 향상시킬 수 있을 것으로 기대된다.

특별인터뷰…유병한 한국저작권위원회 위원장

원성두 한국조사기자협회 2012 조사연구 Vol.24 No.-

저작물 관리와 조사기자의 역할

원성두 한국조사기자협회 2012 조사연구 Vol.24 No.-

The Influence of Daily Stress on Impaired Control through Emotion Dysregulation and Drinking Motives

원성두 한국임상심리학회 2017 Korean Journal of Clinical Psychology Vol.36 No.4

Alcohol use disorder (AUD) can be explained by some emotion-based hypotheses such as the self-medication hypothesis and negative reinforcement model. Accordingly, the aim of this study was to explore the dynamic relationships between daily stress, emotion dysregulation and drinking motives in the prediction of impaired control to drink alcohol in a clinical male sample. Male patients with AUD (n=193) were recruited from alcohol centers of four psychiatric hospitals in South Korea. All participants completed a questionnaire that included the Hassles and Uplifts Scale, the Difficulties in Emotion Regulation Scale (DERS), the Drinking Motives Questionnaire (DMQ), and the Impaired Control Scale (ICS). The serial multiple mediation model analyses showed that daily stress resulted in impaired control through emotional dysregulation and drinking motives in order. Specifically, both emotional dysregulation and drinking motives in turn had partial mediation effects on the relationship between daily stress and impaired control on alcohol. Moreover, when drinking motives were entered as a mediator individually, the size of the indirect effect for coping motives was larger than that of enhancement motives was, suggesting that there might be no gender difference related to drinking motives. These results suggest that daily stress as a precursor indirectly influences impaired control through emotion dysregulation and drinking motives among patients with AUD. Considering the connection between stress and impaired control on alcohol via emotion dysregulation and drinking motives, future interventions need to focus on providing an individualized intervention that includes stress management and adaptive emotion regulation strategies.

자살 시도자에서 혈장 Brain-Derived Neurotrophic Factor 농도 저하

원성두,심세훈,양종철,이헌정,이분희,한창수,김계현,김용구,Won, Seong-Doo,Shim, Se-Hoon,Yang, Jong-Chul,Lee, Heon-Jeong,Lee, Bun-Hee,Han, Chang-Su,Kim, Kye-Hyun,Kim, Yong-Ku 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Objects:Some studies have suggested that brain-derived neurotrophic factor(BDNF), one of the most important neurotrophins, is involved in pathophysiology of depression and suicide. This study was performed to determine whether there is an abnormality in plasma BDNF concentration in suicidal attempters. Methods:The subjects were 71 suicidal attempters who visited emergency rooms in multi-medical centers. All subjects had been interviewed by using Structured Clinical Interview for DSM-IV(SCID), Hamilton Depression Rating Scale(HDRS), Young Mania Rating Scale(YMRS), and Positive And Negative Syndrome Scale(PANSS). The severity of the suicidal behavior was measured by Lethality of Suicide Attempt Rating Scale(LSARS) and Risk-Rescue Rating(RRR) system. Seventy-one age, sex, and diagnosis matched non-suicidal psychiatric patients who were consecutively admitted to a psychiatric ward during the same period recruited as psychiatric controls. They were drug-naive or drug-free at least more than 2 months. In addition, 80 healthy controls were randomly selected as normal controls. Plasma BDNF level was measured by the enzyme linked immunosorbent assay(ELISA) methods. Results:In overall F-test, differences of the plasma BDNF levels among the groups were statistically significant(F=20.226, p<0.001). In the multiple comparisons(Scheffe), while mean levels of plasma BDNF between normal controls and non-suicidal psychiatric patients were similar(p=0.984), the BDNF levels of suicidal attempters were lower than those of other two groups(p<0.001). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal attempters. Conclusion:These results suggest that reduction of plasma BDNF level is related to suicidal behavior and BDNF level may be a biological marker of suicidal behavior.