Korean Clinical Psychology Association

Current Issue

Korean Journal of Clinical Psychology - Vol. 40 , No. 1

[ Original Article ]
Korean Journal of Clinical PsychologyVol. 40, No. 1, pp.60-72
Abbreviation: KJCP
ISSN: 1229-0335 (Print) 2733-4538 (Online)
Print publication date 28 Feb 2021
Received 24 Oct 2020 Revised 28 Oct 2020 Accepted 05 Jan 2021
DOI: https://doi.org/10.15842/kjcp.2021.40.1.005

스마트폰 중독 위험 대학생에 대한 인지적 탈융합 개입의 효능
한경호 ; 조용래
한림대학교 심리학과

The Efficacy of a Cognitive Defusion Intervention for Undergraduate Students at Risk for Smartphone Addiction
Kyoungho Han ; Yongrae Cho
Department of Psychology, Hallym University, Chuncheon, Korea
Correspondence to : Yongrae Cho, Department of Psychology, Hallym University, 1 Hallimdaehak-gil, Chuncheon, Korea; E-mail: yrcho@hallym.ac.kr
Kyoungho Han now works at Bomnae Hospital, Chuncheon.This article has been produced in part from the master’s thesis of the first author, completed under supervision of the second author.


© 2021 Korean Clinical Psychology Association

초록

본 연구는 인지적 탈융합 개입이 스마트폰 중독 위험 대학생들의 스마트폰 과다사용 수준, 우울 증상, 적응기능 곤란, 정신적 웰빙, 탈중심화, 심리적 유연성 부족을 개선하는 데 효과적인지 검증하고자 하였으며, 효과성 비교를 위해 심리교육 개입조건을 활용하였다. 성인 스마트폰 중독 자가진단 척도의 점수에 기초하여 스마트폰 중독 위험 대학생들을 선별한 후에 인지적 탈융합 조건과 심리교육 조건에 무선할당 하였으며, 세 번의 측정 시기(사전, 사후, 추후)에 관련 구성개념들을 측정하는 척도들을 실시하였다. 연구 결과, 심리교육 개입조건에 비해 인지적 탈융합 개입조건에서 스마트폰 과다사용, 우울 증상, 적응기능 곤란 및 심리적 유연성 부족 수준을 감소시키는 데 있어 유의하게 큰 효과를 보였다. 하지만, 탈중심화와 정신적 웰빙에서는 두 개입조건 간의 유의한 차이가 나타나지 않았다. 결론적으로, 이러한 결과들은 인지적 탈융합 개입이 스마트폰 중독 위험 대학생들의 스마트폰 과다사용, 우울 증상, 적응기능 곤란 및 심리적 유연성 부족을 개선하는 데 있어 효과적인 개입임을 시사한다. 마지막으로, 본 연구의 의의, 제한점과 추후 연구를 통해서 밝혀야 할 점에 관해 논의하였다.

Abstract

The purpose of the current study was to examine the efficacy of a cognitive defusion intervention for undergraduate students at risk for smartphone addiction. Thirty-eight undergraduate students who, based on the Smartphone Addiction Scale, had a total score of at least 40, or had an impairment of daily living subscale score of at least 14 were randomly assigned to one of two conditions: (1) the cognitive defusion intervention condition (n=19) or (2) the psychological education condition (n=19). Both the conditions consisted of four weekly 70- to 80-minute sessions and included education about the causes of smartphone overuse. The cognitive defusion intervention group showed significantly greater reductions in smartphone overuse, depressive symptoms, and psychological inflexibility. In addition, the cognitive defusion intervention group showed a significant reduction in functional impairment. However, changes in mental well-being and decentering were not significantly different between the two conditions. In conclusion, these results suggest that the cognitive defusion intervention is efficacious for relieving smartphone overuse, depressive symptoms, functional impairment, and psychological inflexibility of undergraduate students at risk for smartphone addiction. Lastly, the implications and limitations of this study are discussed.


Keywords: smartphone overuse, cognitive defusion, psychological inflexibility, acceptance and commitment therapy
키워드: 스마트폰 과다사용, 인지적 탈융합, 심리적 유연성 부족, 수용전념치료

References
1. Beadman, M. E. (2014). A comparison of cognitive reappraisal, defusion and suppression as emotion regulation strategies in smokers: Effects on smoking behaviour, craving and affect (Doctoral dissertation). University College London, London. Retrieved from https://discovery.ucl.ac.uk/id/eprint/1448222/.
2. Beadman, M. E., Das, R. K., Freeman, T. P., Scragg, P., West, R., & Kamboj, S. K. (2015). A comparison of emotion regulation strategies in response to craving cognitions: Effects on smoking behaviour, craving and affect in dependent smokers. Behaviour Research and Therapy, 69, 29-39.
3. Bernstein, A., Hadash, Y., Lichtash, Y., Tanay, G., Shepherd, K., & Fresco, D. M. (2015). Decentering and related constructs: A critical review and metacognitive processes model. Perspectives on Psychological Science, 10, 599-617.
4. Bianchi, A., & Phillips, J. G. (2005). Psychological predictors of problem mobile phone use. Cyberpsychology and Behavior, 8, 39-51.
5. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., . . . Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire– II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676-688.
6. Chon, K. K., Choi, S. C., & Yang, B. C. (2001). Integrated adaptation of CES-D in Korea. Korean Journal of Health Psychology, 6, 59-76.
7. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (Second edition). Mahwah, New Jersey: Lawrence Erlbaum Associates.
8. Demirci, K., Akgönül, M., & Akpinar, A. (2015). Relationship of smartphone use severity with sleep quality, depression, and anxiety in university students. Journal of Behavioral Addictions, 4, 85-92.
9. Elhai, J. D., Dvorak, R. D., Levine, J. C., & Hall, B. J. (2017). Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders, 207, 251-259.
10. Fledderus, M., Bohlmeijer, E. T., Pieterse, M. E., & Schreurs, K. M. G. (2012). Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: A randomized controlled trial. Psychological Medicine, 42, 485-495.
11. Forman, E. M., Herbert, J. D., Juarascio, A. S., Yeomans, P. D., Zebell, J. A., Goetter, E. M., & Moitra, E. (2012). The Drexel defusion scale: A new measure of experiential distancing. Journal of Contextual Behavioral Science, 1, 55-65.
12. Fresco, D. M., Moore, M. T., Van Dulmen, M. H., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38, 234- 246.
13. Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., . . . Masley, S. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior Therapy, 45, 83-101.
14. Ha, J. M., & Son, C. N. (2016). Effects of acceptance and commitment therapy (ACT) on self-control, depression, and smartphone addiction level in university students with high level of depression and smartphone addiction. Korean Journal of Addiction Psychology, 1, 1-16.
15. Han, A. R., & Cho, Y. R. (2020). Effects of a cognitive defusion intervention for undergraduates with depressive symptoms compared with a distraction intervention and non-treatment control conditions. Korean Journal of Clinical Psychology, 39, 98-110.
16. Han, S. S., & Chang, H. A. (2016). The comprehension and application of cognitive defusion techniques in acceptance commitment therapy (ACT). Social Science Review, 61, 377-398.
17. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25.
18. Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life the new acceptance and commitment therapy. Oakland, California: New Harbinger Publications.
19. Hayes, S. C., & Strosahl, K. D. (2004). A practical guide to acceptance and commitment therapy. New York, New York: Springer Science and Business Media.
20. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, New York: Guilford Publications.
21. Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V., . . . Gregg, J. (2004). A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts. Behavior Therapy, 35, 667-688.
22. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.
23. Heo, J. H., Choi, M. S., & Jin, H. J. (2009). Study on the reliability and validity of the Korean translated Acceptance-Action Questionnaire-2. Korean Journal of Counseling and Psychotherapy, 21, 861-878.
24. Hooper, N., Dack, C., Karekla, M., Niyazi, A., & McHugh, L. (2018). Cognitive defusion versus experiential avoidance in the reduction of smoking behaviour: An experimental and preliminary investigation. Addiction Research and Theory, 26, 1-7.
25. Hooper, N., Sandoz, E. K., Ashton, J., Clarke, A., & McHugh, L. (2012). Comparing thought suppression and acceptance as coping techniques for food cravings. Eating Behaviors, 13, 62-64.
26. Hwang, K. H., Yoo, Y. S., & Cho, O. H. (2012). Smartphone overuse and upper extremity pain, anxiety, depression, and interpersonal relationships among college students. Journal of the Korea Contents Association, 12, 365-375.
27. Jang, A. L. (2013). The effects of cognitive behavior therapy for nursing college students with irritable bowel syndrome (Doctoral dissertation). Pusan National University, Pusan. Retrieved from http:// www.riss.kr/search/detail/DetailView.do?p_mat_type=be54d9- b8bc7cdb09&control_no=3fdfb86511e43508ffe0bdc3ef48d419.
28. Jeon, H. S., & Jang, S. O. (2014). A study on the influence of depression and stress on smartphone addiction among university students: Focused on moderating effect of gender. Korean Journal of Youth Studies, 21, 103-129.
29. Jeong, J. J. (2014). The theoretical foundation and therapeutic techniques of acceptance commitment therapy(ACT) through main concepts. Educational Research Institute, 29, 101-130.
30. Kang, J. Y. (2012). The effect of stress and the way of stress coping, impulsivity of employees on smart-phone addiction (Master’s thesis). The Catholic University of Korea, Bucheon. Retrieved from http://www.riss.kr/link?id=T12638984.
31. Kazdin, A. E. (1979). Nonspecific treatment factors in psychotherapy outcome research. Journal of Consulting and Clinical Psychology, 47, 846-851.
32. Keum, C. M. (2013). Research into smartphone addiction proneness and mental health problem for middle and high school student at Korea (Master’s thesis). Seoul National University, Seoul. Retrieved from http://s-space.snu.ac.kr/bitstream/10371/128005/ 1/000000010050.pdf.
33. Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207-222.
34. Kim, B. N. (2013). The mediating effect of depression on the relationship between self-control and smartphone-addiction in university students. Korean Journal of Family Social Work, 39, 49-81.
35. Kim, B. N., Ko, E. J., & Choi, H. I. (2013). A study on factors affecting smartphone addiction in university students: A focus on differences in classifying risk groups. Studies on Korean Youth, 24, 67-98.
36. Kim, B. N., Lim, Y. J., & Kwon, S. M. (2010). The role of decentering in the relationship between rumination and depressive symptoms. Korean Journal of Clinical Psychology, 29, 573-596.
37. Kim, H., & Lee, H. J. (2008). The effect of statements repetition technique (SRT) on negative mood improvement. Cognitive Behavior Therapy in Korea, 8, 29-40.
38. Kim, S. I., & Baik, J. S. (2013). The effects of acceptance commitment group therapy on college students’ speech anxiety-based on cognitive defusion techniques. Korean Journal of Counseling and Psychotherapy, 25, 19-40.
39. Kim, S. M., Huh, H. J., Cho, H., Kwon, M., Choi, J. H., Ahn, H. J., . . . Kim, D. J. (2014). The effect of depression, impulsivity, and resilience on smartphone addiction in university students. Journal of Korean Neuropsychiatric Association, 53, 214-220.
40. Lee, M. E., Kim, S. G., Park. S. H., Kim, S. H., & Park, J. (2017). The effect of relationship with family, peers and teachers, depression, and anxiety on smartphone addiction in adolescents. Korean Academy of Addiction Psychiatry, 21, 82-87.
41. Lim, Y. J., Ko, Y. G., Shin, H. C., & Cho, Y. R. (2012). Psychometric evaluation of the mental health continuum-short form (MHC-SF) in south Koreans. Korean Journal of General Psychology, 31, 369- 386.
42. Masuda, A., Feinstein, A. B., Wendell, J. W., & Sheehan, S. T. (2010). Cognitive defusion versus thought distraction: A clinical rationale, training, and experiential exercise in altering psychological impacts of negative self-referential thoughts. Behavior Modification, 34, 520-538.
43. Masuda, A., Hayes, S. C., Sackett, C. F., & Twohig, M. P. (2004). Cognitive defusion and self-relevant negative thoughts: Examining the impact of a ninety year old technique. Behaviour Research and Therapy, 42, 477-485.
44. Ministry of Science and ICT. (2020). 2020 The number of wireless communication service registers. Retrieved from https://www. msit.go.kr/SYNAP/skin/doc.html?fn=3667ba4d632367d714fa2 ba02f2df99c&rs=/SYNAP/sn3hcv/result/.
45. Moffitt, R., Brinkworth, G., Noakes, M., & Mohr, P. (2012). A comparison of cognitive restructuring and cognitive defusion as strategies for resisting a craved food. Psychology and Health, 27, 74-90.
46. Moon, H. M. (2006). Development and validation of the program for facilitation of psychological acceptance based on acceptance & commitment therapy model (Doctoral dissertation). The Catholic University of Korea, Bucheon. Retrieved from https://academic. naver.com/article.naver?doc_id=11672482.
47. Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002). The work and social adjustment scale: A simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461- 464.
48. Nam, S. A., Cho, Y. R., & Noh, S. S. (2019). Efficacy of a mindfulness-based intervention for smartphone overuse, functional impairment, and mental health among undergraduate students at risk for smartphone addiction and the mediating role of self-regulation. Korean Journal of Clinical Psychology, 38, 29-44.
49. Naragon-Gainey, K., & DeMarree, K. G. (2017). Structure and validity of measures of decentering and defusion. Psychological Assessment, 29, 935-954.
50. National Information Society Agency. (2011). Development of Korean smartphone addiction proneness scale for youth and adults (NIA IV-PER-11051). Retrieved from https://www.iapc.or.kr/ mediaView.do?idx=28&article_id=ICCART_0000000003541&t ype=A1.
51. National Information Society Agency. (2020). 2019 The survey on smartphone overdependence (NIA VIII-RSE-C-19067). Retrieved from https://www.iapc.or.kr/mediaView.do?idx=28&article_id= ICCART_0000000113015&type=A1.
52. Oh, E. H., & Cho, Y. R. (2014). Effect of cognitive defusion and psychological flexibility on reduction in anxiety responses to a public-speaking situation and attentional bias among undergraduate students. Korean Journal of Clinical Psychology, 33, 341-364.
53. Park, E. M., & Park, K. H. (2014). The mediating effects of depression and aggression on the relationship between perceived parental rearing attitudes and smart phone addiction: A focus on gender differences. Korean Journal of Play Therapy, 17, 209-224.
54. Pots, W. T., Fledderus, M., Meulenbeek, P. A., Peter, M., Schreurs, K. M., & Bohlmeijer, E. T. (2016). Acceptance and commitment therapy as a web-based intervention for depressive symptoms: Randomised controlled trial. The British Journal of Psychiatry, 208, 69-77.
55. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
56. Soni, R., Upadhyay, R., & Jain, M. (2017). Prevalence of smart phone addiction, sleep quality and associated behaviour problems in adolescents. International Journal of Research in Medical Sciences, 5, 515-519.
57. Straub, R. O. (2014). Health psychology. New York, New York: Worth publishers.
58. Thekiso, T. B., Murphy, P., Milnes, J., Lambe, K., Curtin, A., & Farren, C. K. (2015). Acceptance and commitment therapy in the treatment of alcohol use disorder and comorbid affective disorder: A pilot matched control trial. Behavior Therapy, 46, 717-728.
59. Twohig, M. P., & Crosby, J. M. (2010). Acceptance and commitment therapy as a treatment for problematic internet pornography viewing. Behavior Therapy, 41, 285-295.
60. Yu, H. G., & Son, C. N. (2016). Effects of ACT on smartphone addiction level, self-control, and anxiety of college students with smartphone addiction. Journal of Digital Convergence, 14, 415- 426.