우울증을 위한 행동활성화 치료의 적용가능성 : 사례연구

국문 초록 (Abstract)

본 연구는 우울증 감소를 위한 행동활성화 치료가 국내에 적용가능하며 치료효과가 있는지 예비적으로 알아보고자 하였다. 이를 위해 행동활성화(Behavioral Activation) 치료의 원리와 과정에 대해 설명하였으며, 치료를 실시하여 각 사례의 결과를 척도별로 제시하였다. 행동활성화는 우울증 환자의 삶에서 적응적 활동의 빈도를 증가시키고 보상 획득에 방해가 되는 활동을 감소시키는 것을 목표로 한다. 행동활성화는 다수의 대규모 효과성 검증 연구 및 메타분석연구를 통해 우울장애에 대한 단독 치료로서 인정받았으며, 미국심리학회에 의해 우울증의 근거기반치료 중 하나로 채택되었다. 그러나 국내에서는 우울증 환자에게 행동활성화를 적용한 사례가 아직까지 보고되지 않았다. 따라서 행동활성화 치료의 보급을 위해 국내 우울증 환자에게도 적용이 가능한지 그리고 해외의 연구결과와 유사한 효과를 나타내는지 알아보고자 하였다. 본 연구에서는 지역사회 정신건강증진센터에서 의뢰된 우울증 환자 6명 중 연구 포함 및 제외기준을 만족하는 5명을 대상으로 행동활성화 치료 프로그램을 실시하였으며, 치료 사전 및 사후에 2개의 우울증상 평가 척도, 1개의 행동활성화 척도, 2개의 기능 평가 척도를 실시하고 그 결과를 분석하였다. 5명 가운데 4명이 10회기의 그룹치료를 완수하였으며, 그 중 2명이 행동활성화 치료에 반응하였다. 효과 크기는 중간에서 큰 수준 정도로 나타났으며, 이는 국내 지역사회 장면에서 행동활성화 치료를 적용하는 것이 가능함을 시사한다. 앞으로 대규모 무선통제연구를 통해 본 연구의 결과를 재검증하고 타당화 할 필요성이 요구된다.

다국어 초록 (Multilingual Abstract)

The purpose of this study was to provide the rationale and procedures of Behavioral Activation (BA) treatment for depression and to examine feasibility in patients with depression in Korea. The basic principle of the BA is to increase the frequency of adaptive behavior and to decrease engagement in activities that limit access to reward by integrating activity monitoring and activity scheduling into its main therapeutic components. Despite a number of large-scaled effectiveness trials and meta-analysis studies supporting the BA as an independent and efficacious treatment for depressive disorders, none has been reported in this country. To evaluate feasibility of the BA in Korean adults with depressive symptoms, the current study recruited participants from a community mental health center and delivered the 10-session group format BA to five individuals who met the study inclusion and exclusion criteria. At pre- and post-treatment, depressive symptoms, level of functioning, and behavioral activation level were assessed. With minimum drop-out rates (1 out of 5), 50% of the completers showed a large effect size for depressive symptoms, a medium to large for level of functioning, and a medium effect size for behavioral activation level. The current case study supports feasibility and thus future work should replicate the current findings with a larger sample in a controlled manner.

목차 (Table of Contents)

• 요약
• 방법
• 연구 참여자
• 연구 절차
• 평가 도구
• 우울증의 행동활성화
• 분석 방법
• 결과
• 연구 참가자와 프로그램 참여
• 우울 수준
• 행동활성화 수준
• 기능 수준
• 논의
• 참고문헌
• Abstract

참고문헌 (Reference)

1 이지현, "해밀턴 우울증 평가척도의 요인구조" 12 (12): 3-16, 2003

2 박준영, "한국판 Sheehan Disability Scale의 신뢰도와 타당도 연구" 한국임상심리학회 29 (29): 73-81, 2010

3 이중서, "한국판 Hamilton 우울증 평가 척도의 신뢰도, 타당도 연구" 대한신경정신의학회 44 (44): 456-465, 2005

4 전겸구, "통합적 한국판CES-D 개발" 6 (6): 59-76, 2001

5 Kanter, J. W., "What is behavioral activation? : A review of the empirical literature" 30 (30): 608-620, 2010

6 Watkins, P. C., "Unconscious moodcongruent memory bias in depression" 105 (105): 34-41, 1996

7 Plagge, J. M., "Treatment of comorbid pain and PTSD in returning veterans : a collaborative approach utilizing behavioral activation" 14 (14): 1164-1172, 2013

8 Lewinsohn, P. M., "The psychology of depression: Contemporary theory and research" Wiley 1974

9 Dimidjian, S., "The origins and current status of behavioral activation treatments for depression" 7 : 1-38, 2011

10 Lopez, A. D., "The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020" Harvard School of Public Health 1996

11 Radloff, L. S., "The CES-D scale a self-report depression scale for research in the general population" 1 (1): 385-401, 1977

12 Kanter, J. W., "The Behavioral Activation for Depression Scale(BADS) : psychometric properties and factor structure" 29 (29): 191-202, 2007

13 Sheehan, D. V., "The Anxiety disease" Charles Scribner and Sons 1983

14 Cohen, J., "Statistical power analysis for the behavioral sciences" Lawrence Earlbaum Associates 1988

15 O'Hara, M. W., "Selfmonitoring, activity levels, and mood in the development and maintenance of depression" 88 (88): 450-453, 1979

16 Harmon, T. M., "Self-monitoring of mood versus activity by depressed clients" 48 (48): 30-38, 1980

17 Goldman, H. H., "Revising axis V for DSM-IV : a review of measures of social functioning" 149 (149): 1148-1156, 1992

18 Bech, P., "Rating scales for affective disorders : their validity and consistency" 295 : 1-101, 1981

19 Dobson, K. S., "Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression" 76 (76): 468-477, 2008

20 Dimidjian, S., "Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression" 74 (74): 658-670, 2006

21 Demirchyan, A., "Psychometric value of the Center for Epidemiologic Studies Depression(CES-D)scale for screening of depressive symptoms in Armenian population" 133 (133): 489-498, 2011

22 D’Zurilla, T. J., "Predicting social problem solving using personality traits" 50 (50): 142-147, 2011

23 Addis, M. E., "Overcoming depression one step at a time: The new behavioral activation approach to getting your life back" New Harbinger Press 2004

24 Olfson, M., "Mental disorders and disability among patients in a primary care group practice" 154 (154): 1734-1740, 1997

25 Pagoto, S., "Initial investigation of behavioral activation therapy for co-morbid major depressive disorder and obesity" 45 (45): 410-415, 2008

26 Bradley, B. P., "Implicit and explicit memory for emotioncongruent information in clinical depression and anxiety" 33 (33): 755-770, 1995

27 Wang, P. S., "Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication" 62 (62): 603-613, 2005

28 Lloyd, G. G., "Effect of depression on the speed of recall of pleasant and unpleasant experiences" 5 (5): 173-180, 1975

29 Ekers, D. M., "Dissemination of behavioural activation for depression to mental health nurses : training evaluation and benchmarked clinical outcomes" 20 (20): 186-192, 2013

30 American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" American Psychiatric Association 1994

31 Hamilton, M. A. X., "Development of a rating scale for primary depressive illness" 6 (6): 278-296, 1967

32 Mairs, H., "Development and pilot investigation of behavioral activation for negative symptoms" 35 (35): 486-506, 2011

33 Shelley Rhodes, "Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial" Springer Nature 15 (15): 29-, 2014

34 Williams, J. M. G., "Cognitive psychology and emotional disorders" John Wiley & Sons 1988

35 Ekers, D., "Behavioural activation for depression: an update of meta-analysis of effectiveness and sub group analysis" 9 (9): e100100-, 2014

36 Ekers, D., "Behavioural activation delivered by the non-specialist : phase II randomised controlled trial" 198 (198): 66-72, 2011

37 Chen, J., "Behavioural activation : A pilot trial of transdiagnostic treatment for excessive worry" 51 (51): 533-539, 2013

38 Cuijpers, P., "Behavioral activation treatments of depression : A meta-analysis" 27 (27): 318-326, 2007

39 Mazzucchelli, T., "Behavioral activation treatments for depression in adults : a meta‐analysis and review" 16 (16): 383-411, 2009

40 Jacobson, N. S., "Behavioral activation treatment for depression : Returning to contextual roots" 8 (8): 255-270, 2001

41 Hopko, D. R., "Behavioral activation for anxiety disorders" 7 (7): 212-232, 2006

42 Hopko, D. R., "Behavioral activation and the prevention of suicidal behaviors in patients with borderline personality disorder" 17 (17): 460-478, 2003

43 Weinstock, L. M., "Adjunctive behavioral activation for the treatment of bipolar depression : a proof of concept trial" 22 (22): 149-158, 2016

44 Papa, A., "A randomized open trial assessing the feasibility of behavioral activation for pathological grief responding" 44 (44): 639-650, 2013

45 Peckham, A. D., "A meta‐analysis of the magnitude of biased attention in depression" 27 (27): 1135-1142, 2010

46 Ferster, C. B., "A functional analysis of depression" 28 : 857-870, 1973

47 Jacobson, N. S., "A component analysis of cognitive-behavioral treatment for depression" 64 (64): 295-304, 1996

48 Lejuez, C. W., "A brief behavioral activation treatment for depression treatment manual" 25 (25): 255-286, 2001

49 서울대학교 의과대학, "2011년도 정신질환실태 역학조사" 보건복지부 2011