運用理情行為治療理論概念於重鬱症患者之護理經驗

An Experience Applying Rational Emotive Behavior Therapy to Major Depression in Nursing

10.6847/TJPMHN.200906_4(1).0007

張瓊珠(Chiung-Chu Chang)

重鬱症 ； 理性信念 ； 非理性信念 ； 理情行為治療 ； major depression ； rational belief ； irrational belief ； Rational Emotive Behavior Therapy

精神衛生護理雜誌

4卷1期（2009 / 06 / 01）

57 - 64

繁體中文

本文以一位因重鬱症住院的個案，運用Ellis之理情行為治療取向協助個案釐清本身的非理性信念及扭曲的思考，讓個案學習如何分辨理性和非理性的信念，使用駁斥非理性信念的方式產生新的理性信念、情緒及行為，以正向思考的因應方式來面對問題。首先以整體性的護理評估來確立問題，個案所呈現的主要健康問題為：潛在危險性的自殺行為、睡眠型態紊亂和無效性因應能力。透過八次的個別晤談方式，在認知方面駁斥非理性信念，以家庭作業訓練個案，協助其能分辨出非理性的信念。護理結果使個案較能分辨事件、信念、情緒與行為間的關係，知道重新選擇不同的觀點和態度對待自己。且發現個案的認知改變能力優於行動改變和自我評鑑能力。此外，藉由理情行為治療的方式使其睡眠品質、憂鬱情緒與因應能力亦有所改善，且於住院期間無自殺行為。出院後追蹤，發現個案情緒穩定，可從事家務並能持續運用自我信念檢核來改變其非理性的信念。

This article used the Rational Emotive Behavior Therapy of Ellis to provide assistance for a case with major depression in hospital. The treatment was aimed at helping the client to differentiate rational and irrational belief, so that she could reject irrational beliefs and produce new, rational beliefs, emotions and behavior. First we used a holistic nursing assessment to define the problem. The major health problems included a potential for hazardous suicidal behavior, sleep disturbance, and invalid coping. We helped the patient to controvert irrational beliefs in cognition by conducting eight individual interviews and helped her to recognize irrational beliefs by training with homework. We also found that the client's capacity for cognitive change was greater than those for changes in movement and in self-assessment. In addition, we found that REBT could improve the client's quality of sleep, disconsolate emotion and invalid coping. The client exhibited no suicidal behavior in hospital. In post-discharge follow-up, we established that the client's emotion was stable, and that she could handle housework, and continue to differentiate irrational and rational beliefs by using her own self-belief.