인지행동치료가 척수손상 환자의 정신건강, 자기효능감 및 삶의 질에 미치는 영향 = The effect of Cognitive Behavioral Therapy on Mental Health, Self-Efficacy and Quality of Life in Spinal Cord Injury Patients

다국어 초록 (Multilingual Abstract)

Objective : The purpose of this study was to investigate the effects of cognitive behavioral therapy on mental health, self-efficacy, and quality of life after 4 weeks of cognitive behavioral therapy in patients with spinal cord injury.
Methods : The subjects were 20 spinal cord injury patients, and 15 patients in the experimental group and 15 in the control group were randomly divided into the study. The cognitive behavioral therapy program was reconstructed based on previous studies and specialized books, and consisted of a worksheet for cognitive restructuring that changes negative automatic thinking scales into positive ones and a conversation with a therapist for cognitive restructuring, and consisted of a total of 20 sessions. The experimental group received 20 minutes of cognitive behavioral therapy and 30 minutes of traditional occupational therapy in the treatment room, once a day, 5 times a week for a total of 50 minutes, and the control group performed 20 minutes of progressive muscle relaxa/tion and 30 minutes of traditional occupational therapy in the treatment room for a total of 50 minutes, once a day, 5 times a week.
Results : As a result of the study, significant improvement was observed in the experimental group in the items of automatic thinking, depression, anxiety, self-efficacy, and quality of life after within the group after intervention(p<.01). but the control group showed a significant decrease in automatic thinking, A melancholy mood item in the depression test, anxiety (p<.05, p<.01), and a significant improvement in self-efficacy and psychological domain in quality of life(p<.01). As a result of comparing the amount of change between the experimental and control group, there were significant differences in all items of automatic thinking, depression, anxiety, self-efficacy, and quality of life(p<.01, p<.001).
Conclusion : The cognitive behavioral therapy program in this study is significant in that it provided good guidelines for therapists and spinal cord injury patients. In addition, it is expected that emotional stability of spinal cord injury patients due to cognitive behavioral therapy can have a positive effect on future rehabilitation, activities of daily living, and participation.

국문 초록 (Abstract)

연구목적: 본 연구는 척수손상 환자에게 인지행동치료를 4주간 시행 후 정신건강, 자기효능감 및 삶의 질에 미치는 영향을 알아보고자 하였다.
연구방법: 척수손상 환자 30명을 대상으로 하였으며, 실험군 15명, 대조군 15명을 무작위로 나누어 연구를 진행하였다. 인지행동치료 프로그램은 선행연구와 전문 서적을 기반으로 재구성되었고 부정적인 자동적 사고척도를 긍정적으로 변화시키는 인지 재구성을 위한 워크시트 작성 및 인지 재구성을 위한 치료사와의 대화로 이루어지며 총 20회기로 구성하였다. 실험군은 치료실에서 인지행동치료 20분, 전통적인 작업치료 30분 총 50분간 1일 1회, 주 5회 실시하고 대조군은 치료실에서 점진적 근육이완요법 20분, 전통적인 작업치료 30분 총 50분간 1일 1회, 주 5회 실시하였다.
연구결과: 연구결과, 중재 후 집단 내 자동적 사고와 우울, 불안, 자기효능감, 삶의 질 항목에서 실험군은 유의한 변화가 관찰되었으나(p<.01), 대조군은 자동적 사고와 우울증 검사에서 우울 기분 항목, 불안에서 유의한 감소를 보였고(p<.05, p<.01), 자기효능감과 삶의 질의 심리적 영역 항목에서는 유의한 향상을 나타내었다(p<.01). 실험군과 대조군의 집단 간 변화량을 비교한 결과 자동적 사고, 우울, 불안, 자기효능감, 삶의 질 모든 항목에서 유의한 차이가 있는 것으로 나타났다(p<.01, p<.001).
결론: 본 연구에서의 인지행동치료 프로그램은 치료사와 척수손상 환자들에게 좋은 가이드라인을 제시했다는 것에 큰 의의가 있다. 또한, 인지행동치료로 인한 척수손상 환자의 정서적인 안정은 추후 재활, 일상생활활동 및 참여에도 긍정적인 영향을 줄 수 있을 것으로 기대한다.

참고문헌 (Reference)

• 1 안상섭 ; 장덕희 ; 장현갑, "점진적 근육이완훈련과 호흡프로그램이 사회복지사의 만성통증에 미치는 효과" 특수교육재활과학연구소 46 (46): 201-218, 2007
• 2 김영재 ; 서남숙(Seo, Nam-Sook), "점진적 근육이완요법이 항암화학요법환자의 오심과 구토, 피로, 불안 및 우울에 미치는 효과" 대한종양간호학회 10 (10): 171-179, 2010
• 3 오인수, "일반적 자기효능감: 개념, 측정관련 이슈와 인적자원관리 측면의 시사점" 한국산업및조직심리학회 15 (15): 49-72, 2002
• 4 김선민 ; 김종남, "인지행동치료 프로그램이저소득층 아동ㆍ청소년의 우울과 자동적 사고및 또래관계에 미치는 영향" 한국청소년학회 23 (23): 181-208, 2016
• 5 유현숙 ; 이희완 ; 도명애, "인지행동적 집단상담이 양로원 노인의 자아존중감에 미치는 효과" 한국정신건강사회복지학회 40 (40): 117-137, 2012
• 6 오경자 ; 강지현 ; 하은혜 ; 송동호, "우울장애와 불안장애 청소년을 위한 집단 인지행동치료 효과의 예비연구" 한국임상심리학회 23 (23): 263-280, 2004
• 7 신주영 ; 김정민, "성인 ADHD 대학생을 위한 인지행동치료(CBT)와 마음챙김기반 스트레스 감소 개입(MBSR)의 효과 비교 - 인지, 정서 및 실행기능을 중심으로 -" 한국정서행동장애학회 34 (34): 213-236, 2018
• 8 현미열, "사회인지증진을 위한 인지행동집단치료가 만성조현병 환자의 자기효능감, 대인관계기능, 사회생활기술에 미치는 효과" 한국정신간호학회 26 (26): 186-195, 2017
• 9 윤희상 ; 박훈희 ; 이찬우 ; 최승회, "비활동척수장애인의 실태 조사 연구" 국회입법조사처 9 (9): 395-419, 2017
• 10 Beck, A. T., "Thinking and depression: I. idiosyncratic content and cognitive distortions" 9 (9): 324-333, 1963
• 11 Sherer, M., "The self-efficacy scale: Construction and validation" 51 : 663-671, 1982
• 12 McMullin, R. E, "The new handbook of cognitive therapy techniques" Hana medical history 2008
• 13 Lee, B. C., "The effects of cognitive- behavioral group counseling program for stroke patients and their families on their quality of life" 12 (12): 45-59, 2009
• 14 Ji, S. J., "The effects of cognitive behavioral group therapy program on self-efficacy and peer relationship of children with social anxiety" 5 (5): 65-91, 2013
• 15 Jeong, J. Y, "The effect of group cognitive behavior therapy on negative automatic thoughts and aggression of adolescents with conduct problem" Daegu University 2012
• 16 Kim, G. H, "The effect of cognitive-behavioral group counseling on middle schoolers' internet game addiction" Jeju National University 2003
• 17 Na, J. Y., "The effect of cognitive behavioral therapy program on the automatic thought, depression and stress coping methods in depressive patient" Chonnam National University 2012
• 18 Han, J. H, "The effect of activities of daily living performance of patients with spinal cord injury on the quality of lifes" Inje University 2011
• 19 WHOQoL Group, "Study protocol for the world health organization project to develop a quality of life assessment instrument (WHOQOL)" 2 : 153-159, 1993
• 20 Spielberger, C. D., "State-trait anxiety inventory for adults" Mind Garden Inc 1983
• 21 McDonald, J. W., "Spinal-cord injury" 359 (359): 417-425, 2002
• 22 Migliorini, C., "Spinal cord injury and mental health" 42 (42): 309-314, 2008
• 23 Korea Spinal Cord Injury Association, "Report on survey of needs for persons with spinal cord injury" Korea Spinal Cord Injury Association 2021
• 24 Shim, S. H, "Relationship between internet use and quality of Life(QOL) among people with spinal cord injury in Korea" Yonsei University 2008
• 25 Go, H. Y., "Rehabilitation of patients with spinal cord injury rehabilitation medicine" Koonja 745-789, 2014
• 26 Han, T. R., "Rehabilitation medicine" Koonja 2008
• 27 Kwon, S. M., "Korean version of the automatic thinking scale development and utilization" 29 (29): 10-25, 1994
• 28 Lee, M. S., "Korean depression scale" Hakjisa 2005
• 29 Han, D. W., "Korean adaptation of spielberger's STAI(K-STAI)" 1 (1): 1-14, 1996
• 30 Oh, H. S., "Health p romoting b ehaviors and quality of life of Korean women with arthritis" 23 (23): 617-630, 1993
• 31 Kim, E. L, "Factors effect on quality of life of spinal cord injury patients" Ewha woman's University 2000
• 32 Choi, S. E., "Effects of combining cognitive behavioral therapy with bilateral upper limb training in stroke patients: A randomized controlled trial" 2022 : 1-9, 2022
• 33 Gao, J., "Different interventions for post-ischemic stroke depression in different time periods: A singleblind randomized controlled trial with stratification by time after stroke" 31 (31): 71-81, 2017
• 34 Min, S. G., "Development of korean version of WHO quality of life scare abbreviated version(WHOQOLBREF)" 39 (39): 571-579, 2000
• 35 Hollon, S. D., "Cognitive selfstatements in depression: Development of automatic thoughts questionnaire" 4 (4): 383-395, 1980
• 36 Kim, H. J, "Cognitive behavioral therapy for improving parenting efficacy of married immigrant women" Myongji University 2015
• 37 Oei, T. P., "Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic" 220 (220): 1012-1018, 2014
• 38 Beck, A. T., "Anxiety disorders and phobias: A cognitive perspective" Basic books 2005
• 39 Jung, J. S, "A study on psychological factors influence a depression and disability acceptance and the efficacy of short-term psychological intervention for people with spinal cord injury" Korea University 2013