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조현병과 우울장애의 감별 진단 시 다면적 인성검사-Ⅱ(MMPI-2) 내용척도 및 재구성 임상척도의 활용
설순호,신민섭 한국심리치료학회 2012 한국심리치료학회지 Vol.4 No.2
본 연구에서는 조현병과 우울장애의 감별 진단에 있어 MMPI-2의 내용척도와 재구성 임상척도가 기존 임상척도 이상의 추가적인 설명력을 가지는지 확인하고자 하였다. 이에 서울대학교병원 정신건강의학과 에서 치료를 받고 있는 111명의 조현병 환자(편집형 77명)와 74명의 단극성 우울장애 환자를 대상으로 MMPI-2를 실시하였다. 그 결과 임상척도 Hs, D, Hy 척도 외에도 내용척도 ANX, DEP, HEA, BIZ, TRT 와 재구성 임상척도 RCd, RC1에서 유의한 차이가 관찰되었다. 위계적 회귀 분석에서는 임상척도와 내용 척도의 추가적 설명력은 유의미하였으나, 재구성 임상척도의 경우 추가적 설명력이 거의 없었다. 특히 조현병 환자들의 경우 내용척도인 BIZ에서만 유일한 상승이 관찰되고 있어 MMPI-2 해석 시 임상척도와 더불어 내용척도의 고려가 필요해 보인다.
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설순호,권준수,신민섭 대한신경정신의학회 2013 PSYCHIATRY INVESTIGATION Vol.10 No.1
Objective Although several self-report versions of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been developed and used widely, few psychometric studies have established the construct validity of this measure. Therefore, we developed Korean self-report version of the Y-BOCS and evaluated its factor structure, reliability, and validity. Methods A non-clinical student sample (n=206) and a clinical OCD sample (n=199) completed the Korean self-report version and other measures of obsessive-compulsive disorder (OCD), depression, and anxiety. Results Consistent with the originally proposed structure, confirmatory factor analyses supported a factor structure comprised of Obsessions and Compulsions factors in the Korean self-report version. Two subscale scores and the total score of the Korean self-report version showed good internal consistency and convergent validity, but relatively poor discriminant validity. Applying a cutoff score of 16, 84% of OCD patients and 93% of the non-clinical sample were classified correctly. Conclusion Korean self-report version of the Y-BOCS is a psychometrically sound and valid measure for assessing OCD symptoms as compared with the clinician-administered version. The originally proposed division of OCD severity into obsessions and compulsions appears accurate in the Korean self-report version. The cutoff score for the Korean self-report version needs adjustment based on further researches.
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설순호,권석만,신민섭 한국임상심리학회 2007 Korean Journal of Clinical Psychology Vol.26 No.1
Generalized anxiety disorder(GAD) and obsessive-compulsive disorder(OCD) both share ‘excessive, uncontrolled intrusive thought’ as their main symptom. In order to clarify the relationship between GAD and OCD, the present study's aim is to investigate the cognitive appraisal and control strategies regarding three intrusive thoughts - worries, reactive obsessions, and autogenous obsessions. In this study, coping processes for the three subtypes of intrusive thoughts that has been experienced were tested by 174 college students. All three subtypes of intrusive thoughts were found to have importance of thought. But in two of the subtypes - worries and reactive obsessions, thoughts were important because they prevent negative events, reflect real events, and lead to actual behaviors. On the other hand, thoughts were of great importance in autogenous obsessions, because thoughts themselves were considered to be equal with actual behavior and morality. In addition, while both worries and reactive obsessions had high scores of probability and causal responsibility, autogenous obsessions had scored high on disapproval and moral responsibility. A significant difference between worries and reactive obsessions were also found, since worries were found to have higher disapproval scores and lower contingency and therefore higher control of thought. This is why confrontation strategies such as environment control has been used instead of avoidance strategies for reactive obsessions. In contrast, avoidance strategies and confrontation strategies such as social control or reappraisal had been used for worries. Emphasizing the importance of thoughts and a variety of control strategies led this study to seek out specific coping processes of worries, reactive obsessions, and autogenous obsessions.
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신민섭,설순호 한국인지행동치료학회 2007 인지행동치료 Vol.7 No.1
강박장애의 인지행동 모델은 정상적인 침투사고가 강박사고로 변질되는 과정을 잘 설명하고 있다. 즉 과도한 책임감 지각이나 사고에 대한 파국적 오해석 등이 침투사고의 현저성을 증가시키고 중화행동을 더욱 강화시킴으로써 강박장애 메커니즘을 유지시킨다는 것이다. 침투사고에 대한 오류적 평가 및 이에 영향을 미치는 역기능적 신념에는 사고에 대한 과도한 중요성 부여(사고행위 융합), 과도한 책임감, 사고 통제의 중요성, 불확실성에 대한 두려움, 완벽주의, 위협에 대한 과도한 평가 등이 포함된다. 중화행동은 침투적 사고의 불편감을 제거하고 예방하며 사고 자체의 내용을 바꾸기 위해 시도되는 의도적인 통제방략으로, 최근 연구에서는 침투사고 유형에 따라 이러한 인지적 평가와 통제방략이 달라진다는 보고가 있다. 강박장애의 인지행동치료는 노출 및 반응방지 기법을 중심으로 한 행동적 전략을 통하여 강박증상을 유지시키는 중화행동 및 회피행동의 고리를 끊고, 더불어 인지적 전략을 사용하여 환자 들의 왜곡된 평가 및 비합리적 신념을 수정하고 보다 융통성 있고 현실적인 평가로 대체시킨다. 마지막으로 재발 가능성과 이 때 고려해야 할 점들을 언급하였다 Cognitive models for obsessive-compulsive disorder(OCD) have focused particularly on the importance of patients' appraisals of intrusions related to responsibility and overimportance of thoughts. This interpretation results in attempts to both suppress and to neutralize the thoughts, and as a consequence of neutralizing activity, intrusive cognitions become more salient and frequent, they evoke more discomfort, and the probability of further neutralizing increases. A large group of researchers who have studied OCD extensively outlined several types of negative appraisals and dysfunctional beliefs they considered important for the development and persistence of OCD: inflated responsibility, overimportance of thought, importance of controlling one's thoughts, fear of uncertainty, perfectionism, and threat overestimation. Neutralizing is defined as voluntarily initiated activity which is intended to have the effect of reducing discomforts and preventing negative consequences of intrusions. Recently, it suggested that cognitive appraisals and control strategies differ to the types of obsessions. The primary principals of cognitive behavior therapy(CBT) for OCD therefore aims to stop the loop of neutralizing responses and avoidance through exposure and response prevention(ERP), and to modify cognitive errors and displace the maladaptive beliefs to more flexible and reasonable ones using cognitive strategies. Finally, the authors propose the possibility of relapse and considerations.
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