본 연구는 수용-전념 집단 치료를 불안문제에 적용하여 프로그램을 구성하고 그 효과를 검증하였다. 특히 불안에 대한 수용-전념 치료의 이론에 근거해 치료과정 변인을 구체화하여 고찰하였으며, 불안 및 우울 등 호소문제 및 정신건강 상태 뿐 아니라 치료과정 변인의 치료 후 변화 또한 검증하였다. 치료집단은 대학생 및 대학원생과 졸업생 등 일반성인으로 구성되었으며, 총 10회기로 진행되었다. 결과 분석에는 치료 집단 27명과 통제집단 27명 총 54명의 자료가 포함되었다. 연구 결과, 수용-전념 치료집단은 통제집단에 비해 유의하게 상태불안, 특성불안과 우울 등 정서적 불편감이 완화되었으며, 불안통제감 및 불안민감성 등 불안관련 취약성 또한 유의하게 변화되었다. 이러한 치료 효과는 10주 이후 추후에도 유의한 수준으로 유지되었다. 특히 수용-전념치료(Acceptance-Commitment Therapy: ACT)에서 불안에 대한 치료과정 변인으로 가정하고 있는 마음챙김과 사고억제 및 수용행동 그리고 자기자비 또한 치료 후 증진되었다. 본 연구의 의의, 시사점 및 제한점이 논의되었다.
This study hypothesized process variables of ACT for Anxiety and examined the effects of a counseling program on anxiety, which was also based on Acceptance-Commitment Therapy (ACT). In the ACT, process variables were hypothesized to be changed through receiving a treatment and exhibit a therapeutic effect on emotional distress. In doing so, the program was administered to undergraduate and graduate students as well as general public for 10 sessions. The analysis included 27 from the treatment group and 27 from the control group. Results of this study showed that the treatment group reported more decreases in anxiety, depression, anxiety sensitivity, and anxiety controllability than the control group. Furthermore, process variables in ACT for anxiety such as mindfulness, thought suppression, acceptance, and self-compassion increased after receiving treatment. Finally, limitations of the present study and suggestion for future study are discussed.
김광일, 원호택, 이정호, 김광윤 (1978). 간이정신 진단검사(SCL-90-R)의 한국판 표준화연구 Ⅰ: 정상인의 반응특성. 신경정신의학,17, 449-458.
김명소, 김혜원, 차경호 (2001). 심리적 안녕감의 구성개념 분석: 한국 성인 남녀를 대상으로. 한국심리학회지: 사회 및 성격,15(2), 19-39.
김정모 (2006). 한국판 켄터키 마음챙김 기술척도의 타당화 연구. 한국심리학회지: 임상, 25(4), 1123-1139.
김지은, 이선영 (2011). 불안민감성이 불안 증상에 미치는 영향에 대한 마음챙김의 매개효과-일반 성인을 대상으로. 인지행동치료, 11(2), 23-38.
김지혜, 유범희, 오강섭, 양종철, 김율리, 이소영, 임영진 (2004). 한국어 확장판 불안 민감도 지수의 타당화 연구. 신경정신의학,43(1), 54-61.
김정택 (1978). 특성불안과 사회성과의 관계: Spielberger의 STAI를 중심으로. 고려대 학교 대학원 석사학위논문.
문현미 (2006). 심리적 수용 촉진 프로그램의 개발과 효과: 수용-전념 치료 모델을 중심으로. 가톨릭 대학교 박사 학위 청구 논문.
박기환, 안창일 (2001). 사회공포증의 인지 행동집단 치료효과에 대한 연구. 한국 심리학회지: 임상, 20(1), 1-18
오윤희 (2006). 사회불안장애 발병요인의 구조적관계. 고려대학교 박사학위 청구논문.
유상우 (2001). 불안장애의 최신지견과 M.I.N.I소개, GSK Satellite symposium 자료집, 제주도롯데호텔.
이선영 (2010). 수용-전념 치료에서 과정변인이불안에 미치는 매개효과. 고려대학교 박사학위 논문
이선영 (2011). 한국판 사고 억제 척도의 타당화 연구-일반인을 대상으로, 한국 심리학회지: 임상, 30(4), 889-906.
이복동(이선영), 오윤희, 오강섭 (2003). 사회공포증 환자에 있어 지각된 불안통제감이사회적 불편감 및 회피 정도에 미치는 영향. 인지행동치료, 3(1), 81-92.
이선영, 김원 (2008). 불안장애 환자를 대상으로 한 마음챙김과 수용중심치료적 접근:사례연구. 한국심리학회 연차 학술발표대회논문집.
이선영, 한호성, 정은영 (2009). 마음챙김과 수용중심 불안장애 치료의 실제. 서울: 시그마프레스.
이영호, 송종용 (1991). BDI, SDS, MMPI-D척도의 신뢰도 및 타당도에 대한 연구. 한국심리학회지: 임상, 15(1), 98-113.
이정윤, 최정훈 (1997). 사회공포증의 인지행동치료와 노출치료의 효과연구. 한국 심리학회지: 상담과 심리치료, 9, 35-56.
조용래 (2001). 불안장애에 대한 노출치료: 비판적 분석, 작용기제 및 개선방안: 한국심리학회지: 일반, 20(1), 229-257.
조용래 (2009). 자기자비 처치가 불쾌한 자기관련 사건에 대한 반응에 미치는 효과:탈 중심화의 매개역할과 특질 자기자비의중재역할 검증, 한국심리학회 연차대회 자료집.
Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2000). Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review, 21(5), 683-703.
Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.
Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-reports. The Kentucky inventory of mindfulness skills. Psychological Assessment, 11(3), 191-206.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215.
Barlow, D. H., & Craske, M. G. (2000). Mastery of your anxiety and panic (3rded.), New York: Psychological Corporation.
Bond, F. W., & Bunce, D. (2000). Mediators of change in Emotion-Focused and Problem- Focused Worksite Stress Management Interventions. Journal of Occupational Health Psychology, 5(1), 156-163.
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Orcutt, H. K., Waltz, T. & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-Ⅱ: A revised measure of psychological flexibility and acceptance. Behavior Therapy, 42(4), 676-688.
Borkovec, T. D. (2002). Life in the future versus life in the present. Clinical Psychology Science and Practice, 9(1), 76-80.
Brewin, C. R., & Beaton, A. (2002). Thought suppression, intelligence, and working memory capacity. Behavior Research and Therapy, 40(8), 923-930.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848.
Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (pp.542-559). New York: Guilford press.
Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological Interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
Ciarrochi, J., Bilch, L., & Godsel, C. (2010). Psychological flexibility as a mechanism of change in Acceptance and Commitment Therapy. In Ruth Baer's (Ed.), Assessing Mindfulness and Acceptance: Illuminating the. Processes of Change. (pp.51-76). New Harbinger Publications, Inc.: Oakland, CA.
Cosmides, L., & Tobby, J. (2000). Evolutionary psychology and the emotions. In M. Lewis & J. M. Haviland-Jones (Eds.), Handbook of Emotions (PP-91-115). New York: Guilford.
Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: Pilot study. Behavior Modification, 31(5), 543-568.
Degen, L. M. (2008). Acceptance-based emotion regulation, perceptions of control, state mindfulness, anxiety sensitivity, and experiential avoidance: predicting response to hyperventilation. Unpublished doctoral dissertation. American University.
Derogatis, L. R. (1977). SCL-90: Administration, Scoring, and Procedure Manual-Ⅰ. Baltimore, MD: Johns Hopkins.
Deikman, A. J. (1982). The Observing Self. Boston: Beacon Press
Eifert, G. H. & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry. 34(3-4), 293-312.
Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and Commitment Therapy for Anxiety disorders: A Practitioner’s treatment guide to using mindfulness, acceptance, and - value-based behavior change strategies. New harbinger: Oakland, CA.
Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, E., Keller, M., & Langer, D. (2009). Acceptance and commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment protocol. Cognitive and Behavioral Practice, 16(4), 367-484.
Foa, E. B., & Kozak, M. J. (1986). Emotional Process of Fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35.
Foa E. B., & Rothbaum B. A. (1998) Treating the trauma of rape: Cognitive behavioral therapy for PTSD New York: Guilford Press
Forsyth, J. P. (2009). Using Acceptance and Commitment Therapy in the treatment of Anxiety Disorders. CPM Training & Counselling Workshop. Rydges Bell City Convention Centre, Melbourne.
Forsyth, J. P., Parker, J. D., & Finlay, C. G. (2003). Anxiety sensitivity, controllability and experiential avoidance and their relation to drug choice and addiction severity in a residual sample of substance-abusing veterans. Addictive Behaviors(5), 28, 851-870.
Forsyth, J. P., & Eifert, G. H. (2008). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias, and worry with acceptance and commitment therapy. New Harbinger: Oakland, CA.
Gifford, E. V., Kohlenmerg, B. S., Hayes, S. C., & Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-706.
Goldfried, M. R. (2003). Cognitive Behavior Therapy: Reflections on the evaluation of a therapeutic orientation. Cognitive Therapy and Research, 27(1), 53-69.
Gross, J. J. (1998). Antecedent-focused and Response-focused emotion regulation. Journal of Personality and Social Psychology. 74(1), 224-237.
Gross, J. J. (2002). Emotion regulation: Affective, cognitive and Social consequences. Psychophysiology. 39, 281-291.
Hayes, S. C. (1994). Content, context, and the types of psychological acceptance. In S. C. Hayes, N. S. Jacobson, V. M. Follette., & M. J. Dougher. (Eds.), Acceptance and change: Content and context in Psychotherapy (pp.13-32). Reno, NV: Context Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.
Hayes. S. C., Wilson. K. J., 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(6), 1152-1168. 237.
Hayes, S. C., Follette, V. M., & Linehan. M. (Eds.). (2004). Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. New York: Guilford Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Li prollis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behavior Research and Therapy, 44(1), 1-25.
Hofmann, S. G. (2007). Trait affect moderate cortical activation in response to state affect. International Journal of Psychophysiology, 63(3), 258-264.
Hollis-Walker, L. & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness in non-mediators: A theoretical and empirical examination, Personality and Individual Differences, 50(2), 222-227.
Lavy, E. H., & van den Hout, M. A. (1990). Thought suppression induces intrusions. Behavioral Psychotherapy, 18, 251-258.
Kabat-Zinn, J. (1994). Where you go, There you are: Mindfulness meditation in everyday life. New York: Hyperion.
Kabat-Zinn, J., Massion A. O., Kristeller J., Peterson, L. G., Fletcher, K. E., Pbert, L., Lenderking, W. R., & Santorelli, S. F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment anxiety disorders. Journal of Psychiatry, 149(7), 936- 943.
Karekla, M., Forsyth, J. P., & Kelly, M. M. (2004). Emotional avoidance and panicogenic responding to a biological challenge procedure. Behavior Therapy, 35(4), 727-746.
Kashdan, T., B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behavior Research and Therapy, 44(9). 1301-1320.
Kutz, I. (1985). Meditation as an adjunct to psychotherapy: an outcome study. Psychotherapy and Psychosomatics, 43(4), 209-218.
Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implication of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17(3), 193-200.
Mowrer, O. H. (1960). Learning theories of and Behavior. New York: Willey.
Neff, K. D. (2003). Self-compassion: An alternative conceptualization of healthy attitude toward oneself. Self and Identity. 2, 85-101.
Neff, K. D., Rude, S. S., & Kirkpatick, K. L. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139-154.
Notarius, C. I., & Levinson, R. W. (1979). Expressive tendencies and Physiological response to stress. Journal of Personality and Social Psychology, 37(7), 1204-1210.
Ossman, W. A., Wilson, K. G., Storaasli, R. D., & McNeill, J. W. (2006). A Preliminary Investigation of the Use of Acceptance and Commitment Therapy in Group Treatment for Social Phobia. International Journal of Psychology and Psychological Therapy, 6(3), 397-416.
Rapee, R. M., Craske, M. G., Brown, T. A., & Barlow, D. H. (1996). Measurement of perceived control over anxiety-related events. Behavior Therapy, 27(2), 279-293.
Rassin, E. (2003). The white Bear Suppression Inventory(WBSI) focuses on failingsuppression attempts. European Journal of Personality, 17(4), 285-298.
Reiss, S. (1991). Expectancy theory of fear, anxiety and panic. Journal of Clinical Psychology, 11(2), 141-153.
Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In S. Reiss, & R. Bootzin.(Eds.), Theoretical issues in behavior therapy(pp107-121). New York: Academic Press.
Roemer, L., & Orsillo, S. (2002). Expanding our conceptualization of treatment for generalize anxiety disorder: integrating mindfulness/ acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9(1), 54-68.
Rosen, G. M., & Davidson, G. C. (2003). Psychology should list empirically supported principles of Change(ESPs) and not credential trade marked therapies or other treatment packages. Behavior Modification, 27(3), 300-312.
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic modification, social development, and well-being. American Psychologist, 55(1), 68 -78.
Ryff, C. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069-1081.
Salters-Pedneault, K., Tull, M. T., & Roemer, L. (2004). The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology, 11(2), 95-114
Saplosky, R. M. (2007). Stress, stress-related disease and emotion regulation. In J. J. Gross(Ed.). Handbook of emotion regulation (PP.605-615). New York: Guilford Press.
Siegal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press.
Sheehan, D. V., Lecrubier, Y., Sheehan, K.H., Amorin, P., Janavas, J., Weillier, E., Hurgueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The journal of Clinical Psychiatry, 59, 22-57.
Thompson, B. L. & Waltz, J. (2008). Self- Compassion and PTSD Symptom Severity. Journal of Traumatic Stress, 21(6), 556-558.
Twohig, M. P. (2004). ACT for OCD: Abbreviated Treatment Manual. University of Nevada.
Wegner, D. M. (1989). White bear and the other unwanted thoughts: Suppression, obsession, and the psychology of mental control. London: The Guilford Press.
Wegner, D. M., & Zanakos, S. (1984). Chronic thought suppression. Journal of Personality. 62(4), 615-640.
Zettle, R. D. (2003). ACT vs. systematic desensitization in the treatment of mathematics anxiety. The Psychological Record, 53, 197-215.
Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30-38.
