암 경험 유무에 따른 인지도식의 차이: 우울과 불면 증상을 중심으로 = Differences in Cognitive Schema Between Cancer Patients and Healthy Participants with Depressive Symptoms and Insomnia

다국어 초록 (Multilingual Abstract)

Depression and insomnia are the most frequent psychological problems among cancer patients. Some studies report that cognitive schemas may differ in the presence of a serious disease such as cancer, even with the development of the same symptoms of depression and insomnia. The understanding of cognitive schema is a critical component for cognitive behavioral therapy, since its main goal is to reconstruct maladaptive thoughts. In this study, cancer patients and healthy participants experiencing similar levels of depression and insomnia were compared to investigate if there were differences in cognitive schema depending on the presence of cancer. A total of 65 cancer patients (42: experiencing depression, 23: experiencing insomnia), 64 people experiencing depression and insomnia without a cancer diagnosis (22: experiencing depression, 42: experiencing insomnia) and 176 people with no cancer and no psychological problems (98: no depression 78: no insomnia) were recruited. To compare differences in cognitive schema, the dysfunctional attitudes scale, positive automatic thought scale and a computer task measuring emotional bias were administered. To analyze the difference in cognitive schema in the presence of cancer, the groups were classified by matching cancer patients to healthy participants complaing of similar levels of depression and insomnia. A one-way ANOVA showed that the depressed cancer patients had significantly higher levels of dysfunctional cognitive schema than the depressed healthy participants (negative bias, dysfunctional attitude). Also, the cancer patients experiencing insomnia showed significantly higher levels of negative bias than the healthy participants experiencing insomnia without cancer. This study implies that people with depressive symptoms and insomnia symptoms with cancer have higher levels of dysfunctional cognitive schema than those without cancer.

국문 초록 (Abstract)

우울과 불면은 암환자들이 가장 빈번하게 겪는 심리적 문제이며, 효과적인 근거기반 치료로 인지행동치료가 활용되고 있다. 인지도식의 파악은 인지행동치료에 있어 매우 핵심적인 요소로, 일부 연구에서는 같은 우울과 불면 증상이라도 암과 같은 심각한 질병에 의한 경우와 그렇지 않은 경우 인지도식에 차이가 있음을, 다른 연구에서는 차이가 없음을 보고한다. 우울과 불면을 경험하는 암환자들에게 효과적인 개입을 제공하기 위해, 암 유무에 따른 인지도식 차이에 대한 추가적인 탐색이 필요하다. 따라서 본 연구에서는 유사한 수준의 우울과 불면 문제를 경험하는 암환자와 일반인들을 대상으로 암 유무에 따라 인지도식 차이를 살펴보았다. 우울 암환자, 42명, 우울 대조군 22명, 비우울 대조군 98명, 불면 암환자 23명, 불면 대조군 42명, 비불면 대조군 78명이 분석에 포함되었다. 집단별 역기능적 인지도식을 비교하고자 역기능적 태도, 긍정적 자동적 사고, 자신관련단어평가 검사를 실시하였다. 암 여부에 따른 인지도식의 차이를 분석하고자, 유사한 수준의 우울과 불면 문제를 호소하는 암환자와 일반인을 기준에 따라 분류하였다. 분석 결과 우울 암환자가 우울 대조군보다 부정적인 인지도식을 가지고 있음이 나타났으며, 불면 암환자가 불면 대조군보다 부정적인 인지도식을 가지고 있는 것으로 나타났다. 이러한 결과는 우울 또는 불면을 경험하는 암환자가 동일한 증상을 경험하는 대조군에 비해 더욱 역기능적 인지도식을 가지고 있어 인지적 개입이 필요함을 시사한다. 위 같은 결과의 연구적, 임상적 함의와 함께 본 연구의 한계 및 후속 연구를 위한 제언을 논의하였다.

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