성인 애착 불안이 외상 후 스트레스와 성장에 미치는 영향: 자기자비와 반추의 매개효과

하진의 한국상담학회 2013 상담학연구 Vol.14 No.6

The purpose of this study is to investigate comprehensively the mediating effect of self-compassion that is adaptive emotion regulation strategy, and brooding that is maladaptive cognitive emotion regulation strategy, on the path from adult attachment anxiety to posttraumatic stress and growth. To accomplish this end, this study is proposed the hypothetical research model and the competition model 1 and 2. Based on that posttraumatic stress and posttraumatic growth are independent dimensions, the hypothetical research model is that self-compassion and brooding perfectly mediate the relationship between adult attachment anxiety and posttraumatic stress and growth, and the competition model 1 is that self-compassion and brooding partly mediate the relationship between adult attachment anxiety and posttraumatic stress and growth. And based on the assumption that posttraumatic stress is relate to posttraumatic growth, the competition model 2 includes a path that posttraumatic stress affects posttraumatic growth. Participants were 478 college students and general adults, who had experienced trauma and whose subjective severity of the traumatic experience was reported to be above average. And applying two-step approach, the goodness-of-fit and validity of the measurement model was investigated and then the structural equation model was analyzed. As a result of model comparison, the hypothetical research model was the most appropriate model. The major results of the study were as follows. First, adult attachment anxiety has no effect on posttraumatic growth, and has effect on posttraumatic growth through self-compassion indirectly. Second, adult attachment anxiety has no effect on posttraumatic stress, and has effect on posttraumatic stress through brooding indirectly. Third, adult attachment anxiety affects self-compassion, self-compassion affects brooding, in turn, brooding affects posttraumatic stress. Fourth, posttraumatic stress has no effect on posttraumatic growth. 본 연구의 목적은 성인 애착 불안이 외상 후 스트레스와 성장에 영향을 주는 과정에서 적응적인 정서조절 전략인 자기자비와 부적응적인 인지적 정서조절 전략인 반추가 매개효과를 보이는지를 통합적으로 규명하는 것이다. 이를 위해 외상 후 스트레스와 성장이 독립적인 차원이라는 가정에 근거를 두고 성인 애착 불안과 외상 후 스트레스와 성장 간의 관계를 자기자비와 반추가 완전 매개하는 가설적 연구모형과 부분 매개하는 경쟁모형 1, 그리고 외상 후 스트레스와 성장이 관련성을 갖는다는 가정에 근거를 두고 외상 후 스트레스가 성장에 영향을 주는 경로를 포함하는 경쟁모형 2를 설정하였다. 모형검증을 위하여 외상 경험을 보고한 대학생과 일반 성인들 중 주관적 심각도가 평균치보다 높은 478명의 자료를 바탕으로 구조방정식 모형 분석을 실시하였다. 연구결과, 가설적 연구모형이 가장 적합한 모형으로 나타나 간명화 과정을 거쳐 최종 구조적 관계모형으로 채택하고 분석하였다. 연구결과, 첫째, 성인 애착 불안은 자기자비를 완전 매개로 외상 후 성장에 간접적으로 영향을 주었다. 둘째, 성인 애착 불안은 반추를 완전매개로 외상 후 스트레스에 간접적으로 영향을 주었다. 셋째, 성인 애착 불안은 자기자비와 반추를 순차적으로 완전 매개하여 외상 후 스트레스에 간접적으로 영향을 주었다. 넷째, 외상 후 스트레스는 외상 후 성장에 영향을 주지 않았다.

대구지하철 참사 경험 소방관의 외상 후 스트레스

백미례 한국주관성연구학회 2007 주관성연구 Vol.- No.14

The firefighters in Daegu city had participated the subway fire disaster that took 340 casualities at 2003, are still experiencing posttraumatic stress. The purpose of this study was to identify the subjective types and structures of the posttraumatic stress in firefighters who experienced the Daegu subway fire disaster, to develop the Q-block as a assessment tool for types and to identity how types are actually existed in the firefighters. This study used Q-methodology that has been conducted by selecting the 44 statements as a Q sample finally. The analysis identified 3 types of posttraumatic stress :Emotional arousal trauma, Physiological symptom experience, trauma experience persistence.:(1)Emotional arousal trauma have a more mild symptom because they'd endeavored to decrease their stress by an active approach. But increased arousal reactions have been experienced continuously. (2)Physiological symptom experience have a physiological symptom brought by anxiety and strain from not managing the stress. (3)Trauma experience persistence have a trauma experience persistence state that they keep reexperiencing, avoidance and hyperarousal symptoms, This type of firefighter have experienced the most severe posttraumatic stress symptom. Q-block is developed as a assessment tool for large size sample. Q-block contains Q1, Q2, Q3 questionnaire. The Q1-block contains My feeling with regard to the disaster is insensitivity. It seems that my feeling with regard to the disaster is insensitivity as time goes on. The stress has disappeared a little bit when I talked about the disaster. The Q2-block contains I have suffered from the muscular pain or migraine and always been tired after the disaster. It seems that the power of memory and concentration impaired gradually after the disaster. I have frequently suffered from bronchial symptoms and a cold sweat. The Q3-block contains I have tried to avoiding the situation and event that remind me of the disaster. I have been painful when the memory related to the disaster came across my mind suddenly without intent. I have avoided to tell about the disaster because family and friends should be worried about my job, a firefighter. 3 types were distributed into Emotional arousal trauma(52.4%), Trauma experience persistence(34.1%) and Physiological symptom experience(13.5%). Base on the result of this research, this study is showed that firefighters had experienced not only a reexperience of the accident, avoidance and increased hyperarousal symptoms by the diagnosis criteria of American Psychological Association, but also partial posttraumatic stress symptoms of various levels. The need for an institutional system is proposed to decrease posttraumatic stress and to cope with it appropriately through pattern analysis Also this study can help supply crucial data for the development of intervention program for whom suffer posttraumatic stress by firefighters through understanding subjectivity of posttraumatic stress.

소방공무원들에서 긍정심리적 특성이 외상사건 경험 이후 외상후 스트레스 증상 발생에 미치는 영향

박은진,김경의,백현숙,유제춘,최경숙 대한신경정신의학회 2010 신경정신의학 Vol.49 No.6

ObjectivesZZThe purpose of this study was to examine the effects of positive psychological char-acteristics on posttraumatic stress symptoms after traumatic experiences. MethodsZZThe subjects were 97 firefighters (83 males and 14 females), who completed the Life Events Scale, the Rosenberg Self-Esteem Scale, the Connor-Davidson Resilience Scale, and the Im-pact of Event Scale-Revised Korean version. Pearson product-moment correlation coefficients were computed to examine the relationships among the variables, and Structural Equation Modeling was used to investigate the mediation process in the relationships among traumatic experiences, positive psychological characteristics, and posttraumatic stress. ResultsZZThe results showed that self-esteem had a mediating effect on the relationship between traumatic experiences and posttraumatic stress symptoms. Traumatic experiences affected posttraumatic stress symptoms not only directly, but also through self-esteem to posttraumatic stress symptoms. Therefore the lower firefighters’ self-esteem was, the more posttraumatic stress symptoms occurred. Resilience, however, apparently had no function as mediating variable in the relationship between traumatic experiences and posttraumatic stress symptoms. Traumatic experiences and resilience each seemed to affect posttraumatic stress symptoms directly. Hence, the lower firefighters’ resilience was, the more posttraumatic stress symptoms occurred. ConclusionZZThis study showed that self-esteem had a mediating effect on the relationship between traumatic experiences and posttraumatic stress symptoms. We also found that resilience affects posttraumatic stress symptoms directly, regardless of the number of traumatic experiences. Likewise, these results showed that we should be concerned in positive psychological characteristics such as self-esteem and resilience in order to prevent posttraumatic stress symptoms. 그러나 본 연구는 표집 방식의 제한과 연구참여 대상자가 적다는 점에서 연구 결과의 일반화에 어려움이 있으며, 개인의 긍정심리적 특성 중 자아존중감 및 리질리언스만을 살펴본살펴본 점이 제한적이다. 따라서 향후 보다 많은 소방공무원들을 대상으로 PTSD 발병에 영향을 미치는 개인의 긍정심리적 특성에 대한 체계적인 연구가 필요할 것으로 기대된다.

경험 심리치료가 외상 후 스트레스 증상에 미치는 효과: 단일 사례연구

김은실 사단법인 한국융합기술연구학회 2023 아시아태평양융합연구교류논문지 Vol.9 No.1

The purpose of this study was to investigate, as a single case study, whether experiential therapy was effective in reducing post-traumatic stress symptoms in clients suffering from post-traumatic stress disorder after witnessing a suicide. The subject of this study was a 28-year-old female who was diagnosed with posttraumatic stress disorder and had symptoms of insomnia, nightmares, headache, anxiety, and suicidal thoughts. Experimental psychotherapy based on psychodrama was administered to the subjects 5 times. Each session proceeded in the order of 'warm-up', 'main drama', and 'share', which are the basic frameworks of psychological drama, and the main contents were ‘program structuring and stabilization of the autonomic nervous system’, ‘recognizing external and internal receptive senses’, ‘building resources’, ‘dealing with unresolved behaviors and emotions in the event of trauma’, and ‘strengthening the sense of self-control.’ In order to examine the changes in the main symptoms, the pre and post-score changes of the post-traumatic stress and anxiety scales were examined, and the changes in the posttraumatic stress symptoms were examined through behavioral observation and in-depth interviews. As a result, the posttraumatic stress scale score decreased from 40 to 7, and the anxiety scale score decreased from 29 to 12. In addition, hyper-arousal symptoms (headache, insomnia, anxiety) and intrusion symptoms (nightmares, flashbacks, suicidal thoughts) of posttraumatic stress disorder were reduced. Finally, it was helpful for daily adaptation by reducing avoidance behavior caused by posttraumatic stress disorder. These results suggest that experiential psychotherapy is effective in reducing hyper-arousal and intrusion symptoms of posttraumatic stress disorder. 이 연구의 목적은 자살을 목격한 후 외상 후 스트레스 장애를 겪고 있는 연구 참여자에게 경험 심리치료가 외상 후 스트레스 증상 감소에 효과가 있는지를 단일 사례연구로 알아보는 것이다. 연구 참여자(28세, 여)는 외상 후 스트레스장애 진단을 받았으며, 불면증, 악몽, 두통, 불안감, 자살 충동의 증상을 가지고 있었다. 연구 참여자에게 5회의 심리극에 기반한 경험 심리치료를 실시하였다. 매 회기는 ‘웜업(warm-up)’, ‘본극’, ‘나누기’ 순으로 진행되었고, 주요 내용은 ‘프로그램 구조화 및 자율신경계 안정화하기’, ‘외부 및 내부 수용 감각 인식하기’, ‘자원 구축하기’, ‘외상 시 미완성 행동 및 감정 다루기’, ‘자기통제감 강화하기’이었다. 연구 참여자의 주 증상 변화를 알아보기 위해, 외상 후 스트레스 척도와 불안 척도, 그리고 행동 관찰 및 심층면담을 통해 외상 후 스트레스 증상의 변화를 살펴보았다. 연구결과, 외상 후 스트레스 척도 점수는 40에서 7로 감소하였으며, 불안 척도 점수는 29에서 12로 감소하였다. 외상 후 스트레스 장애의 과각성 증상(두통, 불면증, 불안)과 침투 증상(악몽, 플래쉬백, 자살사고)이 현저히 감소하였다. 마지막으로 외상 후 스트레스 장애로 인한 회피 행동 감소로 일상 적응에 도움이 되었다. 이는 경험 심리치료가 외상 후 스트레스 장애의 과각성과 침투 증상 감소에 효과가 있음을 시사한다.

위기상황 스트레스 해소 교육 프로그램 제작을 위한 소방공무원의 외상 후 스트레스 장애 분석

최혜경,김지희 한국자료분석학회 2009 Journal of the Korean Data Analysis Society Vol.11 No.4

The purpose of this study was focused on the posttraumatic stress disorder analysis in Korea fire officers for the critical incident stress debriefing program development. In order to obtain the purpose, following variables were used; 3 independent variables(work burden, stress, stress response), 1 intermediating variable(on-scene stress), and 1 dependent variable (physical symptoms). The respondents were 970 fire officers in Korea from March to December in 2007 by using questionnaires developed by the researchers. Data was analyzed by SPSS 14.0 and AMOS 7.0 programs. Data cleaning was done for the exact data input. For the reliability and validity, exploratory factor analysis and Cronbach's alpha were analyzed. The general peculiarity of the respondents was shown by frequency analysis and descriptive analysis. In order to fulfill this study, the researchers proposed the hypothesis as follows : Work burden and stress will influence upon on-scene stress. Work burden, stress, on-scene stress and stress response will influence upon physical symptoms. Through the structured equation model analysis, the lower the level of work burden, stress and on-scene stress was, the lower the level of physical symptoms became. On the other hand, the higher the stress response was, the lower the level of physical symptoms became. 본 연구의 목적은 소방공무원이 현장에서 겪는 충격 스트레스로 발생하는 외상 후 스트레스장애 분석을 통해 위기상황 스트레스 해소 교육 프로그램 기초 자료를 제시하고자 하는 데 있다. 연구 목적을 달성하기 위하여 독립변인(업무부담감, 스트레스, 스트레스 대응) 3개, 매개변인(현장충격 스트레스) 1개, 종속변인(신체적 증상)으로 구성하여 영향력을 파악하였다. 본 연구 대상자는 전국 970명 소방공무원으로 2007년 3월부터 12월까지 구조화된 설문지를 이용하여 조사하였다. 자료분석은 SPSS 14.0과 AMOS 7.0 통계패키지를 사용하였으며, 정확한 코딩데이터의 입력확인을 위해 데이터클리닝(data cleaning) 작업을 실시하였다. 신뢰도와 타당도를 검정하기 위하여 탐색적 요인분석(exploratory factor analysis)과 Cronbach's 검증을 하였다. 연구대상의 일반적인 특성을 파악하기 위하여 빈도분석(frequency analysis)을 실시하였고, 각 요인에 대한 기술통계분석(descriptive analysis)을 실시하였다. 이 연구의 목적을 달성하기 위하여 설계한 연구가설은 선행 연구의 이론적 근거를 토대로 다음과 같이 설정하였다. 업무 부담감과 스트레스는 현장충격 스트레스에, 업무부담감, 스트레스, 현장충격스트레스, 스트레스대응은 신체적 증상에 영향을 줄 것이다. 가설검증을 위하여 구조방정식 모형분석을 실시한 결과, 업무부담감, 스트레스, 현장충격 스트레스가 낮고, 스트레스 대응이 높을 때 신체적 증상이 낮아지는 것으로 나타났다.

스트레스, 수면생리, 그리고 관련 불면장애

김린 대한의사협회 2010 대한의사협회지 Vol.53 No.8

Excessive stress gives rise to disturbances in various systems in humans and activates defense mechanisms to maintain homeostasis in the body. Sleep is an essential biological process of which the underlying regulating mechanism involves numerous anatomical structures and biochemical substances that can be compromised by stress and the immune system. Immune sub-stances such as interleukin-1βand tumor necrosis factor are related to the homeostatic process of sleep. Interleukin-1βinteracts by being involved in an immune regulating feedback chain that activates the hypothalamo-pituitary-adrenal axis which, in turn, is related to the circadian process. Moreover,stress-induced insomnia activates the hypothalamo-pituitary-adrenal axis further to bring about a vicious cycle of stress and insomnia. The pathophysiological theory responsible for chronic insomnia is that of stressdiathesis, which is a series of processes consisting of predisposition, precipitating,and perpetuating factors. In clinical practice, as the process in which stressinduced insomnia passes into a chronic course is directly related to treatment, the understanding of perpetuating factors is indispensable. Sleep disturbance is a very common complaint among pa-tients with posttraumatic stress disorder. Increased noradrenergic activity and REM sleep dysregul-ation seem to have a role in mediating sleep disturbances of this disorder. Sleep disturbance must always be taken into account as an important clinical variable whenever evaluating or managing stress.

광주민주화운동 피해자들의 외상후 스트레스 장애

신혜랑(Hye Rang Shin),김학렬(Hack Ryul Kim),박상학(Sang Hag Park),이문인(Moon In Lee),이진(Jin Lee),정성윤(Sung Yun Jung),오현정(Hyun Jung Oh),김상훈(Sang Hoon Kim) 대한사회정신의학회 2011 사회정신의학 Vol.16 No.2

목 적 : 본 연구는 5.18 민주화 운동의 현장이었던 광주지역이 아닌 전남지역과 서울/경기지역의 5.18 피해자까지 연구대상을 확대하여 외상후 스트레스 장애의 유병률과 생활 스트레스와 일반 건강 등을 조사하여 5.18 피해자들과 유가족들에 대한 치료적 대안 및 삶의 질 향상을 위한 기초 자료를 얻고자 하였다. 방 법 : 5.18 피해자 113명을 대상으로 하여 교육을 받은 연구원의 직접 방문 및 대상자와의 면접을 통한 설문지 작성(외상후 스트레스 장애 증상 척도-인터뷰 버전, 생활 스트레스 설문지, 일반 정신건강 척도)으로 자료를 수집하였다. 결 과 : 전체 조사 대상자 113명 가운데 29명(25.7%)이 외상후 스트레스 장애로 진단되었고, 엄격한 기준에서 평가하더라도 19명(16.8%) 가 진단될 수 있다. 그러나 소척도에 따르면 41명(36.3%)이 외상후 스트레스 장애에 해당되었다. 외상후 스트레스 장애를 가진 피해 자들은 장애가 없는 피해자에 비해 더 심각한 정도의 우울, 불안, 수면장애, 분노, 사회적 위축, 생활 스트레스를 보고하였다. 결 론 : 조사 대상자의 약 1/4에서 외상후 스트레스 장애를 보였고, 이들은 우울, 불안, 사회적 위축, 생활 스트레스 등의 복합적인 문제를 겪고 있었다. 앞으로 보상 문제뿐만 아니라 외상후 스트레스 장애를 진단받고 치료받을 수 있는 환경의 제공과 시설의 보충이 광주 이외의 지역에도 필요할 것으로 생각된다. Objectives : This study was conducted to assess the development of posttraumatic stress disorder (PTSD) and their life stresses and related general health in victims of Gwangju Democratic Uprising (5 · 18). Methods : Subjects were 113 5 · 18 victims. Data were collected through trained examiners' interview and survey with PSS-I, life stress questionnaire and general health questionnaire. Results : Results showed that 29 victims (25.7%) met the criteria of PTSD and 19 victims (16.8%) met the rigid criteria of PTSD. But, according to the subscales, 41 victims (36.3%) were diagnosed as PTSD. Victims with PTSD had more serious depression, anxiety, sleep disturbance, anger, social withdrawal and life stresses. Conclusion : About one fourth of them were diagnosed as PTSD. Their PTSD symptoms were complicated by the mixtures depression, anxiety and social withdrawal. They still suffer from life stresses.

소방대원의 외상후 스트레스 실태

고봉연,Koh, Bong-Yeun 사단법인 한국응급구조학회 2008 한국응급구조학회지 Vol.12 No.3

Purpose : This study is a descriptive research to provide basic factors of posttraumatic stress in Firefighters. This study was carried out to develop the effective program for the fire fighters to cope with the posttraumatic stress following the disasters. Methods : The questionnaires were collected among fire fighters who serviced in K and I community from April 1 to June 30 in 2008. Total 304 questionnaires were analyzed by SPSS WIN program for descriptive statistics, Pearson's correlation coefficient and t-test. Results : 1. 48.0% of 300 fire fighters were at the age of 31-40, and 42.3% were under 30. 2. Work burden had a significant difference of 2.30 in low-risk group, 2.60 in high-risk group(t-value=-3.85, p=0.00). However, life event had no significant difference 0.79 event in low-risk group, 1.41 event in high-risk group(t-value=-2.27, p=0.24). 3. Concerning posttraumatic stress factors, there was positive correlation between mobilization impact level r=0.38(P<0.01), work burden r=0.38(p<0.01), and life event r=0.27(p<0.01). 4. According to the Symptom Check List-Revised(SCL-90-R), somatization had a significant differences(t-value=5.46, p=0.00), obsessive-compulsive(t-value=7.16, p=0.00), interpersonal sensitivity(t-value=6.15, p=0.00), depression(t-value=6.62, p=0.00), anxiety (t-value=7.33, p=0.00), hostility(t-value=5.94, p=0.00), phobia anxiety(t-value=6.85, p=0.00), paranoid ideation(t-value=5.55, p=0.00), psychotism(t-value=6.52, p=0.00) in low-risk and high-risk group. Conclusion : As a consequence, mobilization impact, work burden, and life event were the influential factors on posttraumatic stress. Also, high-risk group revealed significantly higher score on all 9 scales. The information obtained from surveys made recommendation to develop the intervention of stress management to control mobilization impact and posttraumatic stress.

소방공무원의 업무부담감과 스트레스가 현장충격 스트레스에 미치는 영향

박상섭,정지연,박정현,김지희 한국자료분석학회 2008 Journal of the Korean Data Analysis Society Vol.10 No.5

The purpose of this study was to explain the relationship between job burden and stress on scene stress. The questionnaire research was conducted for 970 fire fighters who work in the fire station from January to December, 2007. The data were analyzed by SPSS 14.0 and AMOS 7.0. The job burden(p<.001) and stress(p<.001) significantly influenced upon the scene stress. The higher the job burden(β=.409), the higher the stress(β= .243), the scene stress became higher. This was expressed by 35.4% of the explanation. Through this data, in order to reduce the scene stress, it is necessary to lessen the job burden and stress. 본 연구는 소방공무원의 업무부담감과 스트레스가 현장출동 시 받는 스트레스와 어떤 관계가 있는가를 검증하고자 하였다. 소방공무원 970명을 대상으로 설문 조사를 하였고, 자료수집은 2007년 1월부터 12월까지 실시하였으며, 자료분석은 SPSS 14.0과 AMOS 7.0 통계패키지를 사용하였다. 업무부담감과 스트레스가 현장충격 스트레스에 미치는 영향을 분석한 결과, 업무부담감(p<.001), 스트레스(p<.001)는 현장충격 스트레스에 유의한 영향을 주는 것으로 나타났다. 업무부담감이 높을수록(β=.409), 스트레스가 높을수록(β=.243) 현장충격 스트레스가 높아지는 것으로 나타났으며, 업무부담감과 스트레스가 현장충격 스트레스를 설명하는 설명력의 정도는 35.4%로 나타났다. 따라서 소방공무원의 업무부담감과 스트레스가 높을수록 현장충격 스트레스가 높아지는 것으로 나타나, 소방공무원의 현장충격 스트레스를 낮추기 위해서는 업무부담감과 스트레스를 낮추어야 하는 것으로 나타났다.

Intranasal Oxytocin following Uncontrollable Stress Blocks Impairments in Hippocampal Plasticity and Recognition Memory in Stressed Rats

Park, Seong-Hae,Kim, Yoon-Jung,Park, Jung-Cheol,Han, Jung-Soo,Choi, Se-Young CAMBRIDGE UNIVERSITY PRESS 2017 INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY Vol.20 No.10

<P><B>Abstract</B></P><P><B>Background</B></P><P>Nasal pretreatment with the neuropeptide oxytocin has been reported to prevent stress-induced impairments in hippocampal synaptic plasticity and spatial memory in rats. However, no study has asked if oxytocin application following a stress experience is effective in rescuing stress-induced impairments.</P><P><B>Methods</B></P><P>Synaptic plasticity was measured in hippocampal Schaffer collateral-CA1 synapses of rats subjected to uncontrollable stress; their cognitive function was examined using an object recognition task.</P><P><B>Results</B></P><P>Impaired induction of long-lasting, long-term potentiation by uncontrollable stress was rescued, as demonstrated both in rats and hippocampal slices. Intranasal oxytocin after experiencing uncontrollable stress blocked cognitive impairments in stressed rats and in stressed hippocampal slices treated with a perfused bath solution containing oxytocin.</P><P><B>Conclusions</B></P><P>These results indicated that posttreatment with oxytocin after experiencing a stressful event can keep synaptic plasticity and cognition function intact, indicating the therapeutic potential of oxytocin for stress-related disorders, including posttraumatic stress disorder.</P>