Korean Clinical Psychology Association
[ Article ]
Korean Journal of Clinical Psychology - Vol. 35, No. 2, pp.309-333
ISSN: 1229-0335 (Print) 2466-197X (Online)
Print publication date May 2016
Received 17 Aug 2015 Revised 20 Feb 2016 Accepted 14 Mar 2016

사회불안장애 인지행동집단치료에서의 치료 반응자 특성 연구: 초기 지표와 치료변화 양상을 중심으로

임수지 ; 김소정 ; 권정혜
고려대학교 심리학과
Treatment Response of Cognitive Behavioral Group Therapy for Social Anxiety Disorder: Indicators of Treatment Response and Process of Change
Sooji Yim ; Sojung Kim ; Jung-Hye Kwon
Department of Psychology, Korea University

Correspondence to: Jung-Hye Kwon, Department of Psychology, Korea University, 5 Anam-Dong, Sungbuk-Gu, Seoul 136-701, South Korea E-mail: junghye@korea.ac.kr

초록

사회불안장애에 대한 인지행동치료는 그 효능과 효과성이 경험적으로 입증되어 있으며, 사회불안장애를 치료하는 데 있어서 최선의 방식으로 권장되는 치료이다. 그러나 이러한 인지행동치료의 효과는 모든 사회불안장애 환자들에게 일관적으로 나타나지 않으며, 치료 종결 시 유의한 향상을 얻지 못한 치료 비반응자 비율의 범위가 25~64%에 이른다. 따라서 사회불안장애에 대한 보다 일관적인 치료 효과를 얻기 위해서는 치료 반응자와 비반응자 특성과 증상 변화 양상에서의 차이를 알아보고 치료 반응을 예측하는 지표가 무엇인지 확인하는 것이 중요하다고 할 수 있다. 이에 본 연구에서는 한국의 성인 사회불안장애 집단을 대상으로 사회불안장애의 인지행동집단치료에 있어서 치료 반응의 지표를 탐색하고, 치료 반응자와 비반응자의 특성을 비교하고자 하였다. 치료 반응자는 사회공포증 척도(SPS)와 사회적 상호작용 불안 척도(SIAS)에서 사회불안 증상 수준이 임상적 수준 이하로 호전되었으며, 동시에 전체 참가자의 점수 감소량의 중앙값 이상의 치료 전후 점수 차이를 보인 사람으로 정의되었다. 총 12회기의 인지행동집단치료를 완료한 39명의 사회불안장애 환자를 대상으로 치료 반응자 집단과 비반응자 집단 간 인구통계학적, 진단적 특징과 초기 증상 수준을 비교하였으며, 치료에 따른 변화 양상을 살펴보았다. 그 결과 치료 반응자 집단과 비반응자 집단 간 인구통계학적 특성 및 진단적 특징에서 차이를 보이지 않았다. 한편, 사회적 수행 불안에 대한 치료 반응자 집단은 초기의 상호작용 불안 수준이 낮은 것으로 나타났으며, 초기의 신체 증상의 경험 정도가 높은 사람들은 사회적 상호작용 불안에 대한 치료 반응성이 낮은 것으로 나타났다. 또한 사회적 수행 불안과 상호작용 불안 각각에 대한 치료 반응자 집단과 비반응자 집단은 인지행동집단치료 프로그램이 진행됨에 따라 각기 다른 변화 양상 차이를 보였다. 사회적 수행 불안 반응자 집단은 비반응자 집단에 비해 자기초점적 주의의 꾸준한 증상 경감을 보였으며, 상호작용 불안 반응자 집단은 비반응자 집단에 비해 역기능적 신념과 부정적 사건에 대한 주관적 확률 및 부담 평정 수준이 더 크게 호전되는 것으로 나타났다.

Abstract

Cognitive behavioral therapy (CBT) is recommended as the treatment of choice for social anxiety disorder (SAD). Despite the well-demonstrated efficacy of CBT, response rates to CBT for SAD are not high; non-response rates are as high as 25~64%. Therefore, finding indicators of treatment response and differences between responders and non-responders seems important for the development of more efficacious treatment. The purpose of this study was to examine indicators of treatment response and compare treatment responders and non-responders to cognitive behavioral group therapy (CBGT) for Koreans with SAD. Thirty-nine individuals who completed 12 sessions of CBGT for SAD were classified as either treatment responders or non-responders according to their post-treatment scores on the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) and to the median SPS and the SIAS change scores. Treatment responders were defined as those who showed over the median change scores and significant symptom reduction in social anxiety from clinical level to non-clinical level. According to the results, there were no significant differences in demographic and diagnostic characteristics between treatment responders and non-responders in the SPS and the SIAS. However, there were differences in the severity of social interaction anxiety at the beginning of treatment between SPS responders and SPS non-responders and somatic symptoms at the beginning of treatment between SIAS responders and SIAS non-responders. In addition, there were significant differences in the patterns of self-focused attention changes during treatment of SPS responders and SPS non-responders even when controlling for initial group differences. The SIAS responders showed a greater reduction in dysfunctional beliefs and probability judgment bias and the cost judgment bias.

Keywords:

treatment response, treatment responders, social anxiety, social anxiety disorder, cognitive behavioral therapy

키워드:

치료 반응, 치료반응자, 사회불안, 사회불안장애, 인지행동치료

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