공황장애의 인지 행동치료 : 치료효과와 치유인자

Abstract

[한글]

공황장애 및 공황발작의 개념에 대한 많은 발전과 함께 인지 행동치료 방법이 많이 향

상되고 성공률도 높아졌다. 공황장애의 비약물적 치료들은 공동발작의 특성에 대한 재교

육, 호흡조절이나 이완훈련, 공황장애와 관련된 부정적 인식에 대한 인지치료, 감각반응

훈련 등의 요소들을 공통적으로 가지고 있으며 약물치료의 제한점들을 보완한 장점을 가

지고 있다. 본 저자는 1991년 10월부터 이러한 4가지 요소를 골격으로 이루어진 인지 행

동치료를 공황장애 환자들을 대상으로 실시하고 있다. 저자는 이러한 인지 행동치료가 실

제로 공황장애 및 임소공포 회피행동에 대해 미치는 치료 효과를 알아보기 위해 치료 전,

후의 증상 변화를 자가평정 불안척도를 이용하여 비교하여 보고 인지 행동치료에서 환자

들에게 치료적 도움이 되었던 요소들을 Yalom의 치료요소 설문지를 사용하여 분석하여 다

음과 같은 결과를 얻었다. 치료 전, 후에 공황장애 환자들은 불안과 공황장애에 대한 자

세한 기전을 이해하고 복용하는 약물의 작용과 효과를 알게 되므로써 불안증상이 완화되

었으며 불안의 신체적 중상에 대한 잘못된 해석과 그에 따른 회피행동에 많은 호전을 보

였다. 치유인자로는 보편성, 집단응집력, 실존적 자각이 효과적인 치유 인자로 판명되었

다.

[영문]

A cognitive-behavioral therapy Program is being applied for Patients with panic

disorder since October 1991. The four main components of the treatment are (1)

education of patient, (2) somatic control exercise, (3) cognitive restructuring,

(4) interoceptive reconditioning and exposure. Author examined the effectiveness of

the treatment by comparing the scores of Patient Rated Anxiety Scale of before and

after the treatment and by using Yalom's Curative Factor Questionnaire to find the

curative factors of the treatment. The results were as follows.

1. Among the total of 24 subjects, 4 were female and 20 were male. The mean age

of subjects was 37.29 years old, 87.50% of subjects were married and average

education was 14 years. Age of onset varried from 17 to 49 and mean age of onset

was 34.79 years old. 75.00% of subjects were accompanied with agoraphobia.

2. Total score of Patient Rated Anxiety Scale before treatment program was 86.63,

of which the scores of endogenous anxiety and exogenous anxiety or phobia were

68.83 and 17.79. After 12 weeks of treatment program, the total score decreased to

48.71 and scores for endogenous anxiety and exogenous anxiety of phobia decreased

to 39.21 and 9.50 which are statistically significant.

3. Although all the scores of the questions in Patient Rated Anxiety Scale showed

statistically significant improvement after the treatment program, physical

symptoms of respiratory system and cognitive symptoms particularly fear of dying or

losing control showed higher improvement.

4. Among Yalom's curative factors, universality, group cohesiveness and

existential factors showed high scores ; 26.37, 24.24 and 24.11. The subjects who

showed much improvement whith our program scored high in altruism compared to those

who did not show such improvement.

5. Within the treatment program, education about medication, physiology of

anxiety and panic and cognitive restructuring were scored high by patients as

therapeutic factors.

The author concluded that cognitive-behavioral therapy is an effective treatment

modality for the treatment of panic disorder.