폭식행동자를 위한 인지행동 집단치료의 도중탈락 예측요인

공성숙 ( Seong Suk Kong ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2000 정신간호학회지 Vol.9 No.3

본 연구는 폭식행동자들을 대상으로 인지행동 집단치료를 시행하였을 때 치료를 종결하지 못하고 도중탈락하는 대상자들을 예측하는 요인들을 알아보기 위해 수행되었다. 치료를 종결한 폭식행동자들과 도중탈락한 대상자들의 특성을 비교한 결과 폭식빈도가 두 집단간에 가장 유의한 차이를 보였다. Blouin 등(1994)은 69명의 폭식증 환자들을 대상으로 인지행동 집단치료를 시행하고 치료의 예측인자를 조사한 결과 폭식빈도와 EDI의 점수가 높은 환자일수록 치료 후 폭식빈도의 감소율이 더 높은 것으로 나타났는데, 이는 증상이 심한 환자일수록 치료에 대한 동기가 높기 때문이거나 혹은 증상이 심한 환자는 폭식빈도가 크게 감소하지만 증상이 약한 사람은 그 낮은 빈도를 줄이기가 더욱 어렵기 때문일 수도 있다고 설명했다. 그러나 Bulick 등(1999)이 인지행동치료에 대해 효과를 나타내는 ‘반응자’와 거의 효과가 없는 ‘무반응자’의 차이를 연구한 결과에서는 반응자들이 무반응자에 비해 치료 전부터 폭식이나 구토 횟수가 유의하게 낮은 것으로 보고했으며, Coker 등(1993)은 치료를 지속하지 못한 환자 집단과 치료를 지속한 환자 집단간에 폭식빈도에는 유의한 차이가 없는 것으로 나타났다. Waller(1997)의 연구에서도 도중탈락자와 치료종결자 사이에는 폭식빈도에 유의한 차이가 없는 것으로 나타나 본 연구와는 상반된 결과를 보이고 있다. 이러한 불일치된 연구결과는 향후 지속적인 반복연구의 필요성을 제시하고 있다. 또한 폭식빈도와 마찬가지로 식이행위의 범주에 속하는 구토빈도는 두 집단간에 유의한 차이가 없는 것으로 나타났는데, 이는 폭식행동자 가운데 ‘하제 비사용형(non-purge type)``에 속하는 대상자들의 경우 폭식삽화만 반복될 뿐 구토나 하제, 이뇨제 사용 등의 보상행동이 나타나지 않기 때문이다. 따라서 두 집단 내에 ’하제 비사용형‘ 대상자의 비율을 통제해야만 구토빈도가 의미있는 변수가 될 것이다. 본 연구에서는 전체 대상자의 수가 많지 않아 이 변수를 통제하지 못한 제한점을 가지고 있다. EDI(다차원적 섭식태도) 도구의 11개 하부척도로 측정한 식이태도 변인 중에서는 대인관계 불신감만이 두 집단간에 유의한 차이가 있는 것으로 나타났다. Blouin 등(1995)의 연구에서는 치료를 종결까지 유지한 환자들의 요인을 판별분석한 결과 대인관계상의 어려움 (interpersonal difficulties)만이 유일한 예측변인으로 나타나 본 연구와 일치된 결과를 보고하였다. 즉, 집단 내에서 다른 구성원에 대한 신뢰감이 떨어지고 대인관계를 잘 맺지 못하는 대상자의 경우 더 쉽게 도중탈락을 보인다는 것이다. 따라서 연구자는 인지행동 치료가 집단치료의 형태로 시행되는 경우 도중탈락율을 줄이기 위해서는 집단내의 ‘집단과정(group process)``과 ‘집단의 응집성(cohesiveness)``이 매우 중요하다고 역설하였다. 또한 이와 같이 대인관계에서 신뢰감이 적은 성격적 요인을 가진 대상자의 경우 집단치료보다는 인지행동 개인 치료에서 치료효과가 더 높은 경향을 보인다고 하였다. 치료전 증상이 지속되어온 유병기간은 치료를 종결한 집단이 도중탈락자 집단보다 더 긴 것으로 나타났다. 이러한 결과는 폭식빈도, 즉 증상의 정도가 심한 환자의 경우 도중탈락율이 적은 것으로 나타난 것과 같은 맥락으로 볼 수 있다. 즉, 증상이 지속된 기간이 길 경우 증상의 정도도 더 심하며 이러한 대상자들은 치료에 대해 동기가 더 높은 것으로 생각된다. 또한 Turnbull 등(1997)은 16주의 인지행동치료와 8주의 자조 프로그램의 치료효과 예측요인을 비교한 결과, 치료전 질병이 지속된 기간이 길수록, 폭식빈도가 적을수록 치료효과가 높다고 보고하여 본 연구의 결과를 지지하였다. Turnbull 등(1997)도 역시 유병기간이 긴 대상자일수록 치료나 회복을 향한 단계를 수행할 준비가 더 잘 되어있기 때문이라고 설명하고 있다. 이와 반대로 유병기간이 짧거나 증상의 정도가 약한 대상자의 경우 증상으로 인한 고통보다는 체중감량에 대한 열망이 더 높기 때문에, 인지행동치료에서 폭식을 유발하는 근원이 되는 다이어트를 중지해야 한다는 중재를 수용하지 못하고 도중탈락하는 경향이 높은 것을 볼 수 있었다. 본 연구에서는 기존의 연구들과는 달리, 신체불만족이나 우울, 자아존중감 변인들은 도중탈락에 영향을 미치지 않는 것으로 나타났다. 이러한 불일치된 결과는 기존의 연구들과 방법론적인 차이점이 많고 치료 및 대상자의 특성에 따른 차이점에 기인한다고 본다. 본 연구에서 뿐 아니라 기존의 연구에서도 대상자의 수가 충분하지 않기 때문에 표본의 대표성이 낮기 때문이다. 향후 폭식 행동자를 대상으로 인지행동 집단치료를 실시하면서 반복적인 연구를 시행하는 것이 중요하다고 하겠다. 또한 개인 인지행동 치료를 받는 집단과의 비교연구가 실행된다면 그 결과가 더욱 명확해질 것이라고 본다. 이상의 연구결과에서 알 수 있듯이 폭식행동자를 대상으로 인지행동 집단치료를 실시했을 때, 도중탈락자에 비해 치료종결자는 높은 폭식빈도와 긴 유병기간, 낮은 대인관계 불신감을 갖고 있으므로, 도중탈락율을 줄이기 위해서는 대상자를 선정할 때 이러한 요인들을 먼저 고려해야 할 것으로 생각된다. 즉, 대인관계 불신감이 높은 대상자에게는 개인 인지행동치료나 개인정신치료를 권장하고, 폭식빈도나 유병기간이 짧은 대상자에게는 다이어트 중지에 대한 권고를 완화시키고 건강한 다이어트 방법을 교육하는 등 중재 접근방법에 수정이 요구된다고 하겠다. Background and purpose : Cognitivebehavioral grouptherapy has become the most popular form of treatment for binge eaters, as it has been demonstrated to be a highly cost-effective method of treating bulimic patients. Unfortunately drop-out rate from group CBT is relatively high. The purpose of this study was to identify predictors of drop-out from cognitive-behavioral group therapy for binge eaters. Prior to treatment, all subjects completed the EDI-2(Eating Disorders Inventory-2), the Rosenberg`s Self-Esteem Scale, the BDI(Beck Depression Inventory), and interviewed the binge and purge frequency per week. In this study, among 41 binge eaters who participated 10-week cognitive-behavioral group therapy, drop-out rate was 36.6%(15 binge eaters). Binge eaters were all women and mean ages of them were 24 years and 95.1% of them were unmarried. 75.6% of them were bulimia nervosa, and the remainders were anorexia nervosa and binge eating disorders. To examine the predictors of drop-out, discriminant analysis was used. The completers were significantly higher in binge frequency and were lower in interpersonal distrust than drop-outs, and in duration of illness the completers also tended to be longer but these univariate differences didn`t reach statistical significance. Wilk`s Lamda was .776 indicating that differences between the completers and drop-outs were significant. The discriminant function analysis was able to successfully predict drop-outs and completers of treatment in 73.2% of cases. Predicted dropouts were correctly identified in 86.7% of cases whereas predicted completers were correctly identified in 65.4% of cases. In conclusion, binge frequency, interpersonal distrust, and duration of illness predicted drop-out from cognitive-behavioral grouptherapy for binge eaters. This results would enable clinicians to more effectively utilize pretreatment assessment information in planning treatment for binge eaters. If patients at risk for dropping out group CBT can be identified at assessment, they may be referred instead to individual CBT, where the likelihood of dropping out is lower. Further research with the larger sample size, and included family factors and personality variables was suggested.

일반 부부와 부부클리닉 방문부부의 결혼만족도에 영향을 미치는 요인

공성숙 ( Seong Suk Kong ) 한국정신간호학회 2006 정신간호학회지 Vol.15 No.4

입원한 정신질환자 가족의 가정간호 요구도와 가족부담감

김소야자,현명선,성경미,공성숙,Kim, So-Ya-Ja,Hyun, Hyung-Sun,Sung, Kung-Mi,Kong, Seong-Suk 대한간호협회 1993 대한간호 Vol.32 No.3

This study was designed to investigate the family burden, family home care needs and to identify the relationship between family burden and home care needs for families of psychiatric in-patients. The subjects for this study were 104 family members of psychiatric in-patients at two private hospitals and one municipal hospital. The data were collected during the period from February 1. 1993 to March 30. 1993. The questionnaire developed by Montgomery to measure the family burden was used as modified by the research team for this study. The questionnaire was developed by Garrad to measure the home care need was also used as modifed by the research team. The data was analyzed using descriptive statistics, t-test, ANOV A and Pearson Correlation Coeffcient. with the SPSS program. The Result of this study can be summarized as follows ; 1. For perceived family burden, the meanscore as measured by the guestionnaire was 70.6 of a possible to total of 110. 2. For home care need. the meanscore as measured by the questionnaire was 44.8 fo a possible total of 66. 3. The results showed a higher score for cases from the municipal hospital for family burden and a higher score for cases at the private hospitals for home care need. 4. Ther was a statistically significantly higher score on family burden for female family member (T =-2.77. P<.05) and for bereaved family members. (F=2.862. p<.05) 5. There was a statistically significantly higher score (F= 10.3535, P<.001) for family burden when the hospitalization period was between 7~ 12 months and a statistically significantly higher score (F =7.679.P<.001) for home care need when the hospitalization period was over 37 months. 6. Ther was a significant correlation between family burden and home care need. (r=.4002, P<.05) The conclusion that can be drawn from this study is that addressing home care needs would contribute to reduce family burden.

청소년 약물남용 실태에 관한 연구

김소야자(Kim, So Ya Ja),현명선(Hyun, Myung Sun),성경미(Sung, Kung Mi),공성숙(Kong, Seong Suk) 한국간호과학회 1993 Journal of Korean Academy of Nursing Vol.23 No.3

폭식 행동에 대한 인지행동 집단치료의 효과

공성숙,김준기,배재현 대한신경정신의학회 2000 신경정신의학 Vol.39 No.6

연구목적 : 본 연구는 폭식행동을 보이는 대상자에게 인지행동 집단치료를 시행하고 폭식이나 구토 등의 식이행위와 식이태도, 자아존중감, 우울에 미치는 효과를 평가하여, 현재 우리 나라에 급증하고 있는 폭식행동자에게 경제적이고 효과적인 치료모델을 제시하는 데에 있다. 방 법 : 식이장애 전문 클리닉인 M병원에 내원한 대상자 중 EAT-26 검사에서 17점 이상인 44명을 대상으로 5차례에 나누어 8-10명 단위로 각 10회의 인지행동 집단치료를 시행하였으며 도중탈락자를 제외한 27명이 참여하였다. 치료 전후에 식이행위 기록지, 다차원적 식이태도 검사(EDI), Rosenberg 자아존중감 척도, 우울 척도(BDI)를 통해 자료를 수집하였으며 식이행위 기록지는 대상자가 매일 적도록 하여 주단위로 변화양상을 분석하였다. 통계방법은 백분율과 paired t-test를 사용하였다. 결 과 : 1) 폭식과 구토빈도는 식이행위 기록지를 분석한 결과 치료 후에 유의하게 감소하였으며, 변화양상은 치료 2주째 급격한 감소를 보였고 초기부터 종결까지 하향곡선을 나타냈다. 2) 식이태도는 '다차원적 식이태도 검사 (EDI)'로 평가한 결과 8개 소척도 중에서 마르고 싶은 욕망, 폭식경험, 신체불만족, 무능감, 내면자각에서는 유의한 감소를 보인 반면, 완벽주의, 대인관계 불신감, 성장 공포에서는 유의한 차이가 없었다. 3) 자아존중감과 우울은 치료 후에 유의하게 감소되었다. 결 론 : 폭식행동자를 대상으로 인지행동 집단치료를 시행한 결과 폭식 및 구토 등의 식이행위와 자아존중감, 우울, 그리고 식이태도의 일부에서 유의한 호전을 보였으나, 식이태도 중 완벽주의, 성장공포, 대인관계 불신감에서 유의한 효과를 보이지 않았다. 이 세 변인들은 인지행동 치료를 통해 변화되기 어려운 성격적 요인으로 생각되며, 폭식행동의 감소와 같은 중요한 변인들에 유의한 효과가 있었으므로 인지행동 집단치료는 향후 우리 나라에서도 폭식행동자를 위한 경제적, 효과적인 치료모델로 제시될 수 있다고 본다. Objectives : The binge eaters are increasing rapidly since 1990's in Korea. The purpose of this study was to examine the effect of cognitive-behavioral group therapy on improving the frequency of binging and purging, eating attitude, self-esteem, and depression. Method : The subjects were 27 women who showed over 17 on the EAT-26 among binge eaters visited at eating disorders clinic "M". 10 sessions of cognitive-behavioral group therapy were provided to each group composed of 8-10 binge eaters. All subjects completed the Eating Disorders Inventory(EDI), Rosenberg Self-Eesteem Scale, Beck Depression Inventory(BDI) pre-and post intervention, and recorded daily food records. Paired t-test was used for the comparison of EDI subscales before and after treatment. Results : Frequency of binging and purging, self-Esteem, depression, drive for thinness, bulimia, body dissatisfaction, ineffectiveness, interoceptive awareness subscales of EDI showed significant immprovement but perfectionism, interpersoual distrust, maturity fear subscales of DEI showed no improvement after the cognitive-behavioral group therapy. Frequency of binging and purging per week showed a general trend of decline from the beginning to the end of the treatment and a rapid decrease at the second week was noticed. Conclusion : The results of this preliminary study suggest that cognitive-behavioral group therapy may be an effective initial approach for the treatment of binge eating. Future research aimed at replicating these initial results and providing systematic long-term evaluation is needed.

일반청소년과 정신장애 청소년의 가족기능

공성숙 대한간호학회정신간호학회 1992 정신간호학회지 Vol.1 No.-

The family is a system which maintains homeostasis through the relationship between family members and interaction with environment. So, the family is of crucial importance to the menta health of the family members who make up the family system. In the adolescent developmental stage, adolescents are very vulnerable mentally because they are irritable emotionally. There are many studies that have reported mental disorders in adolescence as being related to family factors such as difficulties in family interaction and relationship between family members. Most studies about adolescents with mental disorders have dealt with the relationship between varied factors within the family. This descriptive study was done to provide the basic data on adolescents with mental disorders by testing Olson's Circomplex Model which is based on family systems theory. Fifty four adolescents with mental disorders admitted to or attending three hospitals in Seoul for psychiatric care made up the sample for this study. The comparative group was made up of 124 high school and college students with no reported history of psychiatric care. Data collection was carried out by the researcher from March 21 to May 10, 1992. The data were analyzed by SPSS program and the hypotheses were tested using mean score, SD, t-test, x2-test, ANOVA and ANCOVA. The results of this study are as follows : 1. The mean score for the normal adolescents was 34.36, and the mean score for the adolescents with mental disorders was. 31.90. The first hypotheses that there is a difference between the two groups as to the mean score of family cohesion was supported (F=5.2573, p<.05). 2. The mean score for the normal adolescents was 20.10, and the mean score for the adolescents with mental disorders was 27.33. The second hypotheses that there is a difference between the two groups as to the mean score of family adaptability was supported(F=8.7236, p<.05). 3. In normal adolescents, 'Balanced types' was found in 25.0% of the sample, 'Mid-range types' in 58.9%, and 'Extreme types' in 16.1%. In adolescents with mental disorders, 'Balanced types' was found in 35.2% of the sample, 'Mid-range types' in 59.3%, and 'Extreme types' in 5.3%. The third hypotheses that there is a difference between the two groups as to family types was not supported(x2=4.6450, p<.05). 4. Adolescent's age and education level, mother's age, mental disorders in parents and whether the parents were the real parents or not were related to the mean score of family cohesion. Father's education level, mental disorders in parents and whether the parents were the real parents or not were related to the mean score of family adaptability. No statistically significant relation was found between any of the adolescent's characteristics and family types. 5. In the test of difference in the mean score of family cohesion and adaptability between the two groups when the four variables-father's age and job, mental disorders in parents, whether the real parents or not which showed a difference between two groups were controlled, it was found for the varibles father's age and job, there was a difference between the sores for two groups on family cohesion and adaptability. But, for the variables mental disorders in parents and whether the real parents or not, it was found that there was no difference the scores for between two groups on family cohesion and adaptability. This study suggests that there is a need for more studies with matched samples including age and education level of adolescent, age of mother, education level of father, parents with mental disorders and addressing the question of whether parents are the real parents or not as well as more studies with samples including other family members in addition to the adolescents.

청소년 약물남용 예방대책 : 양호교사의 약물교육 효과 연구

김소야자,현명선,성경미,공성숙 연세대학교 교육대학원 1993 연세교육과학 Vol.42 No.-

This study was designed to investigate the knowledge about, and attitude to drugs as found in School Nurses and Education on School Nurses and School Adolescents, and to develop drug abuse prevention strategies. The subject for this studg were 70 School Nurses (42 from Middle schools, 24 from High Schools)and 965 School adolescents(253 Male Middle School Students, 263 Male High School Students, 249 Female Middle School Students, 200 Female High School Students) The Drug Abuse education for the School Nurses was given by this research team during the period from september 22 to 23, 1993 (16 hours). The Drug Abuse education for the School Adolescents was given by the School Nurses for a total of 4 hours. Before and after each Education program, a questionnaire was completed by each subject to evaluate the effect of the Drug abuse Education. The Drug Abuse Prevention Teaching Material for both school Nurses and the School Adolescents was developed by this research team. The questionnaire which measured knowledge about and attitude to drugs was also developed by the research team. The data was analyzed using descriptive Statistics, t-test, ANOVA and Pearson Correlation, with the SPSS program. The result of this study can be summarized as forllows: 1. There was a statistically signifcant difference in knowledge about and attitude to drugs, alcohol, and moking for the School Nurese after the drug abuse educalion program. 2. There was a statistically significant difference in knowledge about and attitude to drugs, alcohol, and Smoking for the School Adolescents after the drug abuse education program. 3. A relationship was found betweed drug use by the fathers of the School adolescent and the School adolescent's Knowledge about and attitude to drugs. As a result of this study, it can be concluded that drug abuse education for school Nurses is neccessary. Further this study showed that drug abuse education by School Nurses can deceease in School Adolescents an attitude which is accepting of drugs and increase Knowledge about drugs. Therefore, this Study suggests directions for adolescent drug abuse prevention stratedise and the Role of the School Nurses in adolescent drug abuse prevention.

청소년 약물남용 예방대책 : - 양호교사의 약물교육 효과 연구 -

김소야자,현명선,성경미,공성숙 연세대학교 교육대학원 1993 연세교육과학 Vol.42 No.1

This study was designed to investigate the knowledge about, and attitude to drugs as found in School Nurses and Education on School Nurses and School Adolescents, and to develop drug abuse prevention strategies. The subject for this studg were 70 School Nurses (42 from Middle schools, 24 from High Schools) and 965 School adolescents(253 Male Middle School Students, 263 Male High School Students, 249 Female Middle School Students, 200 Female High School Students). The Drug Abuse education for the School Nurses was given by this research team during the period from september 22 to 23, 1993 (16 hours). The Drug Abuse education for the School Adolescents was given by the School Nurses for a total of 4 hours. Before and after each Education program, a questionnaire was completed by each subject to evaluate the effect of the Drug abuse Education. The Drug Abuse Prevention Teaching Material for both School Nurses and the School Adolescents was developed by this research team. The questionnaire which measured knowledge about and attitude to drugs was also developed by the research team. The data was analyzed using descriptive Statistics, t-test, ANOVA and Pearson Correlation, with the SPSS program. The result of this study can be summarized as forllows : 1. There was a statistically signifcant difference in knowledge about and attitude to drugs, alcohol, and moking for the School Nurese after the drug abuse educalion program. 2. There was a statistically significant difference in knowledge about and attitude to drugs, alcohol, and Smoking for the School Adolescents after the drug abuse education program. 3. A relationship was found betweed drug use by the fathers of the School adolescent and the School adolescent's Knowledge about and attitude to drugs. As a result of this study, it can be concluded that drug abuse education for school Nurses is necessary. Further this study showed that drug abuse education by School Nurses can deceease in School Adolescents an attitude which is accepting of drugs and increase Knowledge about drugs. Therefore, this Study suggests directions for adolescent drug abuse prevention stratedise and the Role of the School Nurses in adolescent drug abuse prevention.