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범불안장애의 근거기반심리치료

Evidence-based Treatment of Generalized Anxiety Disorder

김근향
한국임상심리학회 (Korean Clinical Psychology Association)|2017.11|Korean Journal of Clinical Psychology|제36권 제4호|pp. 494-508|DOI https://doi.org/10.15842/kjcp.2017.36.4.004

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참고문헌

키워드

근거기반치료evidence-based treatment심리치료 효과성psychotherapy effectiveness범불안generalized anxiety범불안장애worry걱정GAD
주제분류심리과학

초록

본 논문의 목적은 GAD의 국내외 최근 심리치료 관련 연구들을 개관하고 그에 따라 근거기반 심리치료에 대한 권고안을 제시하는 것이다. 병리적 걱정과 범불안을 주요 특징으로 하는 GAD는 다른 정신장애와 공병하는 경우가 많으며 세계적으로 유병률이 증가하고 있지만 불안장애군 중에서 상대적으로 적은 관심과 더불어 연구도 적었다. 해외에서는 Cognitive Behavioral Therapy (CBT), Applied Relaxation (AR), Psychodynamic Therapy (PDT), Meta-cognitive Therapy (MCT), Mindfulness-based Therapy (MBT), Worry Exposure (WE) 등이 적용되어 왔고 그 중 CBT (strong), AR (modest)은 그 효과성이 경험적으로 지지되는 수준이었으며 MBT는 실험적 수준으로 그 효과성에 대해 확정하기가 곤란하였다. 국내에서는 심리치료의 종류와는 별개로 GAD 심리치료 효과성을 검증한 논문이 미미하여 근거기반의수준을 상정하는 것조차 불가하였다. 대신 국내연구는 일반인을 대상으로 GAD 관련 요인들(예, IU 등)에 관한 연구에 편중되어 있어 향후GAD 환자들을 대상으로 한 무선통제(RCT) 연구들이 이루어져야 할 것이며 그러한 자료가 누적되면 근거기반의 수준을 정할 수 있을 것으로 보인다. 또한 GAD 치료 접근성을 높이고자 웹 및 앱 프로그램과 유용 사이트 등을 소개하였다. 마지막으로 GAD에 대한 근거기반 심리치료의 최종 권고안을 제안한 후 GAD 및 GAD 심리치료의 적용 및 연구 방향에 대해 논의하였다

Abstract

The purpose of this study is to review recent domestic and overseas studies pertaining to psychological therapies for generalized anxiety disorder (GAD), and to offer guidelines for evidence-based treatment for GAD. Despite its high rates of comorbidity with other mental disorders and its rising worldwide prevalence, GAD has been given relatively little research attention compared to other anxiety disorders. According to overseas studies, the efficacy of Cognitive Behavioral Therapy (CBT), Applied Relaxation (AR), Psychodynamic Therapy (PDT), Meta-cognitive Therapy (MCT), Mindfulness-based Therapy (MBT), and Worry Exposure (WE) have been repeatedly verified, with strong and modest efficacy being ascribed to CBT and AR, respectively. It is difficult to definitively verify the efficacies of MBTs since most MBT studies have been open trials and preliminary studies. There has been little domestic research on the efficacy of psychotherapy for GAD, which makes it impossible to even set appropriate levels for evidence-based treatments. Instead, domestic studies are primarily focused on GAD-related factors such as IU in the general population. Thus, systematic RCTs in patients with GAD need to be conducted and accumulated before the criteria for national evidence-based treatments can be defined. In addition, Internet-based treatments and related applications, which promote an understanding of GAD and the accessibility of GAD treatments, are introduced. Finally, guidelines for evidence-based treatments of GAD based on recent research will be offered, and potentially beneficial points for future research on GAD and its treatments, as well as further implications of this study will be discussed.

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