運用認知治療照護身體畸形合併重度憂鬱症病人的護理經驗

Nursing Experience of Using Cognitive Therapy in a Patient with Body Dysmorphic Disorder and Major Depressive Disorder

10.6530/YYN.2014.8(2).11

蘇碧玉(Pi-Yu Su)

身體畸形合併重度憂鬱症 ； 認知治療 ； 身體心像紊亂 ； body dysmorphic disorder ； cognitive behavioral therapy ； body image disturbance

源遠護理

8卷2期（2014 / 08 / 01）

70 - 78

繁體中文

本文描述運用短期認知治療照護一位身體畸形疾患合併重度憂鬱症病人的經驗。於民國101年10月27日至101年11月6日，藉由關懷、同理心、情緒支持及定期會談與個案建立治療性關係，並運用五大層面護理評估，發現個案有：身體心像紊亂、低自尊、社交互動障礙及睡眠形態紊亂等問題。筆者透過為期11天共6次的短期認知治療及自我紀錄方式，加強個案自我察覺能力，使其瞭解負向自動化思考源自認知的偏差。發現藉由短期認知治療能使個案以正向思考面對壓力源、重建自信與自我價值。個案出院後連續三週的電話追蹤發現此正向思考模式能持續運用在現實生活的壓力情境。藉由本文的分享，冀望精神科護理人員，在面對身體畸形合併重鬱症患者時，能運用短期認知治療改善其負向思考。

This article presents a case using short-term cognitive-behavior therapy to effectively manage a physically dysmorphic man with major depressive disorder. A comprehensive psychiatric nursing assessment of the patient revealed four major health problems: body image disturbance, low self-esteem, impaired social interaction and sleep pattern disturbance. The patient received six sessions of cognitive-behavior therapy and self-recording during his 11 inpatient days. The goals were to enhance his self-awareness and identification of negative thoughts. The health problems improved gradually; particularly in the reduction of negative thoughts. During the three-week telephone follow-up, the patient reported that he was able to continue the positive thoughts when he encountered real life stressors. In conclusion, the short-term cognitive-behavior therapy may reduce the frequency of negative thoughts in individuals with major depressive disorder complicated by body dysmorphic disorder.