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비자살적 자해를 위한 단기 변증법적 행동치료의 적용 사례 예비연구 : 여자 대학생 사례를 중심으로

Pilot Study of a Brief Dialectical Behavioral Therapy for Non-Suicidal Self-Injury : Case Reports of Two Female College Students

구훈정|최유주|김명숙|강예령
한국여성심리학회 (The Korean Society For Woman Psychology)|2024.06|한국심리학회지:여성 (The Korean Journal of Woman Psychology)|제29권 제2호|pp. 165-197|DOI 10.18205/kpa.2024.29.2.003

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참고문헌

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대학생사례 연구Case ReportNon-Suicidal Self-Injury비자살적 자해변증법적 행동치료DBT단기 치료Brief Therapy

초록

최근 대학생 내 비자살적 자해의 발생비율의 증가에도 불구하고, 아직 국내에서는 비자살적 자해행동을 보이는 대학생을 대상으로 한 표준화된 치료법의 보고가 활발하지 않다. 본 연구에서는 기존 장기간 이루어지는 변증법적 행동치료(DBT)의 시간과 비용의 현실적 제한점을 보완한 10회기의 단기 DBT 프로그램을 개발하고 이를 2명의 대학생에게 적용한 치료 사례를 보고하고자 한다. 사례 1은 업무에 대한 압박감과 부모와의 갈등 상황에서 촉발된 부정적 자동적 사고가 자기혐오로 이어져 부정적 정서에 압도되는 상태에서의 자해 충동이 자해행동으로 발전하는 경우였으며, 표적행동에 이르는 취약성 요인과 방아쇠 및 연결고리를 인지적으로 파악하고 셀프 모니터링하며 위기대처기술을 활용하는 것에 초점을 두었다. 사례 2는 대인관계 스트레스 상황에서 자기비난을 하며 처벌의 의미로 자해 행동을 하게 되는 경우로, 자해 충동과 자해 행동이 나타나기까지의 과정에서 감정상태에 대한 마음 챙김과 비판단적 사고를 통한 자해 행동의 지연 및 중단에 초점을 맞추었다. 두 사례 모두 비자살적 자해행동의 체인분석을 통하여 자신의 표적행동의 연결고리를 깨닫고 이러한 연결고리를 끊기 위한 시도로서 정서조절 기법을 적용하여 표적행동을 지연 혹은 중단하는데 성공하였다. 추후 보다 많은 사례들의 축적 및 비교연구를 통해 본 비자살적 자해행동 감소를 위한 단기 DBT 프로그램의 효과가 입증되어야 할 것이다.

Abstract

Despite the recent increase in the incidence rate of non-suicidal self-injury( NSSI) among college students, there are still no active reports of standardized treatments targeting college students with non-suicidal self-injurious behaviors in Korea. In this study, we developed 10-session short-term DBT program that complemented the realistic limitations of time and costs of existing long-term dialectical behavior therapy (DBT) and then applied a short term DBT to two female college students. Case 1 was an instance where negative automatic thoughts triggered by work-related stress and conflict with parents led to self-loathing. This evolved into an overwhelming state of negative emotions, where impulses for self-injury developed into actual self-injury behavior. The intervention focused on cognitively recognizing the vulnerability factors, triggers, and links that led to these target behaviors, emphasizing self-monitoring and the application of crisis management skills. In Case 2, the individual engaged in self-injury as a form of punishment, driven by self-criticism in situations of interpersonal stress. The focus was on delaying and stopping self-injury behavior through mindfulness of emotional states and non-judgmental thinking in the process leading up to the appearance of self-injury impulses and self-injury behavior. In both cases, by the practice of using chain analysis of non-suicidal self-injurious behavior, they realized the link between their target behavior and succeeded in delaying or stopping the target behavior by applying emotion regulation skills in an attempt to break this link. The effectiveness of this short-term DBT program for reducing non-suicidal self-injury behavior should be proven through the accumulation of more cases and comparative studies in the future.

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