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메뉴본 연구에서는 우울증이나 불안장애의 치료법으로 알려진 인지행동치료(Cognitive Behavioral Therapy: CBT)와 수용전념치료(Acceptance & Commitment Therapy: ACT)가 각 장애의 취약성 요인인 반추와 걱정을 낮추고 회복력 요인인 수용을 증진시키는지를 검증하였다. 반추와 걱정 수준이 높아 우울증이나 불안장애에 취약하다고 여겨지는 13명을 무선으로 CBT와 ACT에 배정하여 매주 90분 총 8회기 동안 프로그램을 진행하였다. 프로그램 전후에 반추적 반응양식 척도, 펜스테이트 걱정질문지, 상태 불안검사, Beck 우울검사, 수용 및 행동질문지(AAQ), 역기능적 태도 척도(DAS), 자동적 사고 질문지(ATQ)를 실시하였다. 그 결과, CBT와 ACT는 모두 우울과 불안의 취약 요인인 반추와 걱정사고를 감소 시켰고, 회복력 요인인 상위인지적 수용 정도를 증가시켰다. 또한 두 프로그램은 모두 불안과 우울의 증상과 함께 불안과 우울의 인지적 요소로 알려진 역기능적 신념과 부정적 자동사고도 감소시켰다. 이러한 결과들을 바탕으로 이들 치료 프로그램의 취약 집단에 대한 표적치료 효과와 본 연구의 제한점을 논의하였다.
This study compared the effectiveness of CBT and ACT in decreasing vulnerability and increasing resiliency in participants with depression and anxiety disorder. Twelve participants were randomized and treated using either ACT or CBT interventions. They attended an 8-week program consisting of 90 minute sessions each week. The Rumination Response Mode Scale, the Penn State Worry Questionnaire, the State Anxiety Inventory, the Beck Depression Inventory, the Acceptance and Action Questionnaire, the Dysfunctional Attitude Scale, and the Automatic Thought Questionnaire were administered as pre-and posttests. Results of the study found that both programs relieved depression and anxiety symptoms, decreased rumination and worry (known vulnerability factors of depression), increased metacognitive awareness and acceptance (known resiliency factors of both depression and anxiety), and decreased dysfunctional beliefs and negative automatic thoughts (known cognitive factors of depression). Based on these results, the usefulness of traditional treatment programs in preventive programs and the limitations are discussed.
강민지, 김미리혜, 김정호 (2011). 수용전념치료가 유방암 환자의 부정정서, 수용 및 삶의 질에 미치는 효과에 대한 예비연구. 한국심리학회지: 건강, 20(1), 3, 17-34.
김두현, 손정락 (2016). 수용전념치료(ACT)가사회불안장애 경향이 있는 대학생의 사회불안, 거절민감성 및 수용에 미치는 효과. 한국심리학회지: 임상, 35(1), 101-119.
김문영, 정현희 (2003). 인지-행동적 집단상담이 노인의 우울과 고독감, 역기능적 태도에 미치는 효과. 한국심리학회지: 상담 및 심리치료, 15(3), 477-490.
김정주 (2011). 여고생의 스트레스와 심리적 안녕감 및 마음챙김과 수용행동 간 관계. 석사학위논문, 전남대학교.
김정원, 민병배 (1998). 걱정과 불확실성에 대한 인내력 부족 및 문제해결 방식의 관계. 한국심리학회 연차학술대회 학술발표논문집. 한국심리학회.
김정택, 신동균 (1978). STAI의 표준화에 관한연구. 최신의학, 21, 70-72.
김용수 (2014). 알아차림 프로그램이 초등 교사들의 상위인지자각과 수용행동에 미치는 효과. 상담학연구, 15(2), 811-830.
고윤정, 김정민 (2015). 사회불안장애 여자 대학생을 위한 인지행동치료와 수용전념치료의 효과 비교. 정서․행동장애연구. 31(2) 175-197.
권석만 (1994). 한국판 역기능적 태도척도의신뢰도, 타당도 및 요인구조. 심리과학, 3, 100-111.
권석만, 윤호균 (1994). 한국판 자동적 사고척도의 개발과 활용. 학생연구, 29, 10-25.
문현미 (2006). 심리적 수용 촉진 프로그램의 개발과 효과: 수용-전념 치료 모델을 중심으로. 가톨릭대학교 대학원 박사학위 청구논문
신우승 (2006). 우울한 기분에서 취할 수 있는내부 초점적 반응양식의 구분. 서울대학교대학원 석사학위 청구논문.
안혜원 (2008). 싸띠명상이 중학생의 마음챙김, 심리적 수용 및 심리적 안녕감에 미치는 효과. 석사학위논문, 경성대학교.
오인옥 (1998). 인지행동 집단치료가 여대생의우울과 자아존중감에 미치는 효과. 정신간호학회지, 7(2), 257-272.
이서준 (2016). 알코올사용장애 환자의 불면증에대한 수용전념치료(ACT)의 효과. 충북대학교 대학원 석사학위 청구논문.
이선영, 안창일 (2012). 불안에 대한 수용-전념치료의 치료과정 변인과 치료효과. 한국심리학회지: 상담 및 심리치료. 24(2), 223-254.
이영호, 송종용 (1991). BDI, SDS, MMPI-D 척도의 신뢰도 및 타당도에 대한 연구. 한국심리학회지: 임상, 10, 98-113.
정효경, 윤효균 (2005). 집단상담에서의 상위인지적 자각과 상담성과의 관계. 한국심리학회지: 상담 및 심리치료, 17(4), 769-787.
조현주 (2003). 산후 우울증의 위험요인 탐색과예방개입의 효과. 고려대학교 대학원 박사학위 청구논문.
Albee, G. W. (1982). Preventing psychopathology and promoting human potential. American Psychologist, 37, 1043-1050.
Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomizes controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139.
Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.
Bearman, S. K., Stice, E., & Chase, A. (2003). Evaluation of an intervention targeting both depressive and bulimic pathology: A randomized prevention trial. Behavioral Therapy, 34, 277-293.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Beck, A. T., Hollon, S. D., Young, J E., Bedrosian, R. C., & Budenz, D. (1985). Treatment of depression with cognitive therapy and amitriptyline. Archives of General Psychiatry, 42, 142-148.
Beck, A. T., Ward, C. H., Mendalson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
Beck, J. S. (1995). Cognitive therapy: Basic and beyond. New York: The Guilford Press.
Blagden, J. C., & Craske, M. G. (1996). Effects of active and passive rumination and distraction:A pilot replication with anxious mood. Journal of Anxiety Disorders, 10, 243-252.
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotional-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.
Bond, F. W., & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057-1067.
Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611-619.
Borkovec, T. D., Newman, M. G., Lytle, R., & Pincus, A. (2002). A component analysis of cognitive behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288-298.
Borkovec, T. D., & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. Journal of Clinical Psychiatry, 62, (suppl. 11), 37-42.
Brown, T., O’Leary, T., & Barlow, D. H. (2007). Generalized anxiety disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders (Fourth Edition). New York:Guilford Press.
Butler, A. C., & Beck, J. S. (2000). Cognitive therpay outcomes: A review of meta-analysis. Journal of the Norwegian Psychological Association, 37, 1-9.
Bulter, G., Fennell, M., Robson, P., & Gelder, M. (1991). Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 59, 167-175.
Cardaciotto, L. A. (2005). Assessing mindfulness:The development of a bi-dimensional measure of awareness and acceptance. Unpublished doctoral dissertation, Drexel. University, Philadelphia.
Clark, G., Hawkins, W., Murphy, M., Sheeber, L., B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of group cognitive therapy. Journal of the American Academy of Child & Adolescents Psychiatry, 34, 312-321.
Clark, G., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W. Elizabeth, O., & Seely, J. (2001). A randomized trial of group cognitive intervention for preventing depression in adolescents offspring of depressed patients. Archives of General Psychiatry, 58, 1127-1134.
Cowen, E. L., Hightower, A. D., Perdo-Carroll, J. L., & Work, W. C. (1996). School-based prevention for children at risk: The Primary Mental Health Project. Washington, DC:American Psychological Association.
Davison, G., C., Neale, J. M., & Kring, A. M. (2004). Abnormal psychology, (9th ed.). John Wiley & Sons, Inc.
DeRubeis R. J., Webb C. A., Tang T. Z., Beck A. T. Cognitive therapy. In: Dobson KS, editor. Handbook of cognitive-behavioral therapies. 3rd ed. Guilford; New York: 2010.
Digman, J. M. (1994). Child personality and temperament: Does the five-factor model embrace both domains? In C. F. Halverson, G. A. Kohnstamm, & R. P. Martin (Eds.), The developing structure of temperament and personality from infancy to adulthood (pp. 323-338). Hillsdale, NJ: Erlbaum.
Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414-419.
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, 293-312.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Gomez, R. (1998). Locus of control and avoidance coping: Direct, interactional and mediating effects on maladjustment in adolescents. Personality and Individual Differences, 24, 325-334.
Gomez, R., Holmberg, K., Bounds, J., Fullarton, C., & Gomez, A. (1999). Neuroticism and extraversion as predictors of coping styles during early adolescence. Personality and Individual Differences, 27, 3-17.
Gomez, R., & McLaren, S. (2006). The association of avoidance coping style, and perceived mother and father support with anxiety/depression among late adolescents:Applicability of resiliency models. Personality and Individual Differences 40, 1165-1176.
Haby, M. M., Tonge, B., Littlefield, L., Carter, R., & Vos, T. (2004). Cost-effectiveness of cognitive behavioral therapy and selective serotonin reuptake inhibitors for major depression in children and adolescents. Australian & New Zwaland Journal of Psychiatry, 38(8), 579-591.
Harrington, R., Whittaker, J., & Shoebridge, P. (1998). Psychological treatment of depression in children and adolescents. British Journal of Psychiatry, 173, 291-298.
Hass, J. R. (1994). The elusive nature of acceptance. In S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance and change: Content and context in psychotherapy (pp.33-36). Reno, NV: Context Press.
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. (2004). Acceptance and commitment therapy and the new behavior therapies:Mindfulness, acceptance, and relationship. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance Expanding the cognitive-behavioral tradition (pp.1-29). New York: Guilford.
Hayes, S. C., Hope, D. A., & Hayes, S. (2007). Towards an understanding of the process and mechanism of change in cognitive behavioral therapy: Linking innovative methodology with fundamental questions. Clinical Psychological Review, 27, 679-681.
Hayes, S. C., Strosahl, K., Wilson, K., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M., Dyksta, T. A., Batten, S. V., Bergan, J., Stewart, S. H., Zvolensky, M. J., Eifert, G. H., Bond, F. W., Fosyth, J. P., Karekla, M., & Mccurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guildford Press.
Hayes, S. C., Wilson, K. G., Afari, N., & McCurry, S. (2003). The use of Acceptance and Commitment therapy in the treatment of agoraphobia. Paper presented at meeting of the Association for Advancement of Behavior Therapy, San Francisco.
Hollon, S. D., & Beck, A. T. (1994). Cognitive therapy of depression. In P. C. Kendall, & S. D. Hollon (Eds.), Cognitive-behavioral interventions:Theory, research, and procedures (pp. 153-203). New York: Academic Press.
Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garveym M. J., Grove, W. M., & Tuason, V. B. (1992). Cognitive therapy and pharmacotherapy for depression:Singly and in combination. Archives of General Psychiatry, 49, 774-781.
Hollen, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cognitive Therapeutic Research. 4, 383-395.
Hong, R. Y. (2007). Worry and rumination:Differential association with anxious and depression symptoms and coping behavior. Behaviour Research and Therapy. 45, 277-290.
Ingram, R. E., Miranda, J., & Segal, Z. V. (1998). Cognitive vulnerability to depression. New York:The Guilford Press.
Kaslow, N. J., & Thompson, M. P. (1998). Applying the criteria for empirically supported treatments to studies of psychological intervention for child and adolescent depression. Journal of Clinical Child Psychology, 27, 146-155.
Kuyken, W., Watkins, E., & Holden, E. (2006). Rumination in adolescents at risk for depression. Journal of Affective Disorders, 96, 39-47.
Kwon, S. M., & Oei, T. P. S. (2003). Cognitive change process in a group cognitive behavior therapy of depression. Journal of Behavior Therapy and Experimental Psychiatry, 34, 73-85.
Lee, K. H., Lee, H. J., & Woody, S. R. (2009). Mediating Effects of Worry, Rumination, and Coping Style in the Links Among Life Stress, Temperaments, and Negative Affect. The Journal of Stress Resrarch 17(3) 265-276.
Lewinsohn, P. M., Muñoz, R. F., Youngren, M. A., & Zeiss, A. M. (1978). Control Your Depression. Englewood Cliffs, NJ: Prentice-Hall.
Linehan, M. M. (1989). Cognitive behavioral therapy for borderline personality disorder. In A. Tasman, R, E, Hales, A. J. Frances (Eds.), Review of psychiatry (Vol. 8, pp. 84-102). Washington, DC: American Psychiatric Press.
Lopez, F. J. C. (2000). Acceptance and commitment therapy (ACT) in panic disorder with agoraphobia: A case study. Psychology in Spain, 4, 120-128.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Developmental and validation of the Penn State Worry Questionnaire. Behavioral Research and Therapy, 28, 487-495.
Mineka, S., Watson, D., & Clark, L. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377-412.
Molina, S., Borkovec, T. D., Peasley, C., & Person, D. (1988). Content analysis of worrisome streams of consciousness in anxious and dysphoric participants. Cognitive Therapy and Research, 22, 109-123.
Montessino, F. (2003). ACT, sexual desire orientation and erectile dysfunction: A case study. Analisis y Modificación de Conducta, 29, 291-320.
Muris, P., Roelofs, J., Rassin E., Franken I., & Mayer, B. (2005). Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Personality and Individual Differences 39, 1105-1111.
Nelson, T. O., Stuart, R. B., Howard, C., & Crowley, M. (1999). Metacognition and clinical psychology: A preliminary framework for research and practice. Clinical Psychology and Psychotherapy, 6, 73-79.
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504-582.
Nolen-Hoeksema, S., Morrow, J., & Fredrickson, B. L. (1993). Responses styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102, 20-28.
Oei T. P. S., Bullbeck K., & Campbell J., M. (2006). Cognitive change process during group cognitive behaviour therapy for depression. Journal of Affective Disorders 92, 231-241.
Papageorgiou, C., & Wells, A. (2001). Positive beliefs about rumination: Development and preliminary validation of a self-report scale. Behavior therapy, 32, 13-26.
Paul, P. H., Marx, B. P., & Orsillo, S. M. (1999). Acceptance-based psychotherapy in the treatment of an adjusted exhibitionist: A case example. Behavior Therapy, 30, 149-162.
Peden, A. R., Rayens, M. K., Hall, L. A., & Beebe, L. H. (2001). Preventing depression in high-risk college women: A report of an 18-month follow-up. Journal of American College Health, 49, 299-306.
Rehm, L. P., Wagner, A. L., & Ivens, C. (2001). Mood Disorders: Unipolar and Bipolar. In P. B. Sutker & H. E. Adams (Eds.), Comprehensive handbook of psychology (pp. 277-308). New York: Kluwer Academic/Plenum Publishers.
Scott, M. J., & Stradling, S. G. (1990). Group cognitive therapy for depression procedures clinically significant reliable change in community-based settings. Behavioral Psychotherapy, 18, 1-19.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. New York: Guildford Press.
Seiffge-Krenke, I., & Klessinger, N. (2000). Long-term effects of avoidance coping on adolescents' depressive symptoms. Journal of Youth and Adolescence, 29, 617-630.
Seligman, M. E. P. (1991). Learned optimism. New York: Knopt.
Seligman, M. E. P., Schulman, P., DeRubeis, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention and Treatment, 2, Article 8, posted December 21.
Seligman, M. E., Schulman P., & Tryon A. M. (2007). Group Prevention of depression and anxiety symptoms. Behaviour Research and Therapy, 45, 1111-1126.
Shapiro, S. L., Astin J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12, 164-176
Sheppard, L. C., & Teasdale, J. D. (2004). How does dysfunctional thinking decrease during recovering from major depression? Journal of Abnormal Psychology, 113(1), 64-71.
Singer, A. R., & Dobson, K. S. (2007). An experimental investigation of the cognitive vulnerability to depression. Behavior Research and Therapy, 45, 563-575.
Spielberger, C. D., Gorsuch, R., & Lushene, R. (1970). The state-trait anxiety inventory(STAI)test manual. Palo Alto: Consulting Psychologists Press.
Starcevic, V. (1995). Pathological worry in major depression: A preliminary report. Behavior Research and Therapy, 33, 55-56.
Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, H., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence, Journal of Consulting and Clinical Psychology, 70(2), 275-287.
Teasdal, E. J. D., Scott, J., Moore, R. G., Hayhurst. H., Pope, M., & Paykel, E. S. (2001). How does cognitive therapy prevent relapse in residual depression? Evidence from a controlled trial. Journal of Consulting Clinical Psychology. 69(3), 347-357.
Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behavior Research & Therapy, 33, 25-39.
Watkins E. (2009). Depressive rumination:investigating mechanisms to improve cognitive-behavioral treatments. Cognitive Behavior Therapy, 38, 8-14.
Watkins, E., Scott, J., Wingrove, J., Rimes, K., Bathurst, N., Steiner, H., Kennel-Webb, S., Moudls, M., & Malliaris, Y. (2007). Rumination-focused cognitive behaviour therapy for residual depression: A case series. Behaviour Research and Therapy, 45, 2144-2154
Watkins, E., & Teasdale, J. D. (2001). Rumination and over-general memory in depression: Effects of self-focused and analytic thinking, Journal of Abnormal Psychology, 110, 353-357.
Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97, 346-353.
Watson, D., Gamez, W., & Simms, L. J. (2004). Basic dimensions of temperament and their relation to anxiety and depression: A symptom-based perspective. Journal of Research in Personality, 39, 46-66.
Weismann, A. N., & Beck, A. T. (1978). Development and Validation of the Dysfunctional Attitude Scale. Paper presented at the annual meeting of the Association for the Advanced of Behavior Therapy, Chicago, USA.
Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester, UK: Wiley.
Wells, A. (2007). Cognition about cognition:Metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice, 14, 18-25.
Wells, A., & Mattews, G. (1994). Attention and Emotion: A Clinical Perspective. Hove, UK:Erlbaum.
Zettle, R. D. (1994). Discussion of Dougher: On the Use of Acceptable Language. In S. C. Hayes, N. S. Jacobson, V. M. Tollette, & M. J. Doughter(Eds). Acceptance and change: Content and context in psychotherapy (pp. 46-50). Reno, NV: Context Press.
Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization in treatment of mathematics anxiety. 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.
Zettle, R. D., & Raines, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438-445.
Zinbarg, R. E., Craske, M. G., & Barlow, D. H. (2006). Mastery of your anxiety and worry:Therapist guide (Second Edition). Oxford University Press.