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조현병 환자를 위한 마음이론 향상 재활 프로그램의 효과 검증

A Study on the efficacy of a Social Cognition Enhancing Rehabilitation Program (SERP) focused on Theory of Mind for individuals with Schizophrenia in the Community

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참고문헌

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초록

본 연구는 마음이론 능력의 향상에 초점을 둔 사회인지 재활프로그램을 개발하고, 조현병 환자들을 대상으로 그 효과를 검증하고자 실시되었다. 조현병 환자를 위한 마음이론 향상 프로그램은 권정혜(2003)가 개발하고, Choi와 Kwon(2006)이 효과를 검증한 조현병 환자를 위한 사회인지 재활프로그램 중 실언 및 타인의 의도 파악과 관련된 만화 14개를 추려 회기를 구성하고, 여기에 오리엔테이션, 전체 마무리 각각 1회기를 더해 총 16회기로 이루어졌다. 마음이론 향상 프로그램은 마음이론 능력을 증진시키고 이에 따라 사회인지 능력과 대인관계 능력이 향상될 것을 가정하며, 일상생활에서의 기능 증진과 직업 및 사회 활동에서의 유능성을 함양시키는 것을 목표로 한다. 본 프로그램의 치료효과를 검증하기 위해 서울특별시에 위치한 정신보건센터와 지역사회 복귀시설에 등록된 조현병 환자들을 대상으로 치료집단 36명과 통제집단 16명이 구성되었다. 이 중 프로그램 전체 회기를 끝까지 마친 치료집단 23명과 검사 참여에 응한 통제집단 14명이 사후평가에 포함되었다. 마음이론 능력 및 전반적인 사회인지 능력, 사회적 기능에 대해 프로그램 시작 전과 마친 후에 평가를 하였다. 연구 결과, 치료집단은 통제집단에 비해 타인의 의도와 감정을 추론하는 마음이론 능력에서 향상을 보였다. 그러나 상황적 도식과 사회적인 인과관계를 이해하는 사회인지 능력에서는 유의한 향상이 나타나지 않았다. 사회적 기능의 경우, 세부적인 사회기술 능력 향상에는 효과가 있었으나 대인관계 기능에서는 향상을 보이지 않았다. 이러한 연구 결과는 마음이론 향상 재활 프로그램이 단기적으로 실시될 경우, 마음이론 능력과 사회기술 능력을 향상시키는 데에는 효과적이나, 사회적 상황과 맥락정보를 이해하는 능력을 증진시키고 대인관계 능력의 향상을 보이는 데는 제한이 있음을 시사한다.

Abstract

People with schizophrenia show major deficits in social cognition, especially theory of mind (ToM). Social cognitive deficits are promising treatment targets for new interventions to improve functional outcome in schizophrenia. The purpose of this study was to examine the efficacy of a Social-Cognition Rehabilitation Program (SERP) focused on theory of mind. This program was modified from the original version, developed by Kwon (2003) and verified by Choi and Kwon (2006), especially for improvement of theory of mind. The SERP focused on theory of mind was composed of 16 sessions, including 14 sessions dealing with faux pas, hidden intentions and emotions and one session each for orientation and ending. The aim of the program was to help individuals with schizophrenia to enhance social cognition including theory of mind and ultimately to promote daily social skills and interpersonal ability. The SERP focused on theory of mind was compared with treatment as usual within a two group pre-post design in 52 people with schizophrenia in the community. Theory of mind, social cognition and functional outcome were assessed before and after the eight week training phase. Patients in the treatment group showed significant improvement theory of mind and social skill abilities after the program, but not in general social cognition and interpersonal abilities. Our findings suggested that theory of mind could be improved in people with schizophrenia by implementation of a social cognition enhancing rehabilitation program focused on theory of mind. Conduct of further study will be needed in order to determine whether enhanced theory of mind will have an effect on general social cognition.

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