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강박장애에 대한 근거기반치료

Evidence-based Treatment of Obsessive-Compulsive Disorder

신민섭|김일중
한국임상심리학회 (Korean Clinical Psychology Association)|2017.11|Korean Journal of Clinical Psychology|제36권 제4호|pp. 509-525|DOI https://doi.org/10.15842/kjcp.2017.36.4.005

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참고문헌

키워드

근거기반치료evidence-based treatment인지행동치료cognitive behavioral therapy강박장애obsessive-compulsive disorder인지치료cognitive therapy노출 및 반응방지exposure and response prevention
주제분류심리과학

초록

본 논문에서는 강박장애에 대한 국내외 근거기반치료를 검토하였으며 주로 노출 및 반응방지 기법과 인지치료를 포괄하는 인지행동치료와 수용전념치료의 효과에 대해 다루었다. 미국심리학회의 임상심리학분과에서는 무선할당통제연구에 대한 메타분석과 체계적 리뷰를근거로 노출 및 반응방지 기법과 인지치료를 “잘 확립된 치료법(strong/well-established)”으로, 수용전념치료를 “효과가 있음직한 치료법(modest/probably efficacious)”으로 제안하였다. 그러나 국내에서 실시된 연구를 개관한 결과, 강박장애에 대한 인지행동치료 및 수용전념치료의 효과를 검증한 무선할당통제연구는 전혀 없었으며 집단 인지행동치료의 효과를 검증하기 위해 실시된 1편의 사전-사후 설계 연구와 컴퓨터 기반 인지행동치료의 효과를 검증하기 위해 실시된 1편의 준실험설계 연구가 검색되었다. 이를 통해 국내에서는 인지행동치료를 강박장애에 대한 “효과가 있음직한 치료법”으로 제안할 수 있다. 마지막으로 강박장애 치료 과정에서 발생할 수 있는 문제점과 치료적제안 및 향후 연구 방향을 제시하였다.

Abstract

This paper presents a current review of existing evidence-based treatments for Obsessive-Compulsive Disorder (OCD), with a description of “Cognitive Behavioral Therapy” (CBT), which encompasses “Exposure and Response Prevention” (ERP) and “Cognitive Therapy” (CT), and “Acceptance and Commitment Therapy” (ACT). Based on meta-analyses and systematic reviews including randomized-controlled trials (RCTs), American Psychological Association (division 12) suggests that both ERP and CT have a “strong/well-established” evidence base, and ACT has a “modest/probably efficacious” evidence base. A literature search for domestic clinical trials, however, revealed that while no RCTs had examined the efficacy of CBT or ACT for OCD, a pretest-posttest design trial had examined the efficacy of group CBT and a quasi-experimental design trial had examined computer-based CBT. Based on this evidence, CBT for OCD is deemed to have a “modest/probably efficacious” evidence base in Korea. Finally, challenges to the treatment of OCD and future directions are suggested.

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