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우리나라 청소년은 높은 자살률, 학교폭력, 가족붕괴, 각종 재난 및 재해로 인한 사고까지 다양한 외상적인 상실을 경험하고 있다. 하지만 아직까지 국내에는 청소년 애도와 관련된 연구가 매우 부족한 실정이다. 본 연구에서는 상실을 경험한 아동․청소년을 위한 근거기반 치료모델인 외상중심 인지행동치료(Trauma-Focused Cognitive Behavioral Therapy: TF-CBT)를 바탕으로 애도 집단상담 프로그램을 개발하고 효과를 검증하였다. A광역시 소재 중학교 2개교에서 관계상실을 경험한 중학교 3학년 31명을 모집한 후, 처치집단(TF-CBT 기반 애도 집단상담 프로그램), 적극적 대조집단(지지적 집단상담 프로그램), 대기통제집단에 성별과 상실유형을 고려해 무선할당 하였다. 반복측정 이원변량분석을 실시한 결과, 처치집단은 적극적 대조집단이나 대기통제집단에 비해 애도슬픔, 내재화 및 외현화 증상, 외상후 스트레스 문제 점수가 유의미하게 감소되었고 외상후 성장 점수는 유의미하게 증가되었다. 이러한 처치효과는 프로그램 종료 4주 후에도 유지되는 것으로 나타났다. 연구결과를 바탕으로 TF-CBT 기반 애도 집단상담 프로그램 효과 검증에 대한 한계와 후속연구에 대한 제언을 논의하였다.
Korean adolescents are increasingly experiencing traumatic loss from suicide, school violence, family breakdown, and national disaster; however, little research on Korean adolescents with grief issues has been conducted. The current study aimed to develop a group counseling program based on Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and to verify its effectiveness. Participants included volunteering 31 9th graders from two different schools who have experienced relationship loss. Students were randomly assigned to one of the following three groups based on gender and type of loss experienced: a treatment group (TF-CBT group), an active comparison group (Supportive Therapy group), and a wait-list control group. Repeated Two-way ANOVA revealed significant differences among the groups in all areas; treatment group reported significantly lower grief, internalizing symptoms, externalizing symptoms, and posstraumatic stress, and significantly higher posstraumatic growth. Treatment effects were found to last 4 weeks after program completion. Implications and suggestions for future research were discussed based on the findings.
김선하, 김춘경 (2010). 대인관계 집단치료와인지행동 집단치료가 청소년 우울 및 관련 변인에 미치는 효과. 청소년학연구, 17(3), 55-86.
김진수, 서수균 (2011). 친밀한 관계경험과 성장적 반추가 외상후 성장에 미치는 영향. 한국심리학회지: 일반, 30(3), 793-809.
김창대, 김형수, 신을진, 이상희, 최한나 (2011). 상담 및 심리교육 프로그램 개발과 평가. 서울: 학지사.
노안영, 강영신 (2003). 성격심리학. 서울: 학지사.
배주미, 김동민, 정슬기, 강태훈, 박현진 (2010). 2010년 전국 청소년 위기 실태조사. 청소년상담연구, 154, 63-65.
서영석, 조화진, 안하얀, 이정선 (2012). 청소년들의 외상사건 경험. 교육심리연구, 26(3), 787-816.
안영란 (2006). 배우자 사별여성을 위한 개별적사별 중재 프로그램의 개발과 효과. 가톨릭대학교 간호학박사학위논문.
오경자, 하은혜, 이혜련, 홍강의 (2001). K-YSR 청소년 자기행동 평가척도. 서울: 중앙적성출판사.
오승주, 최세민 (2015). 인지행동이론을 활용한집단미술치료가 비행청소년의 애착과 분노에 미친 영향. 청소년 시설환경, 13(4), 129-137.
유승은 (2007). 아동․청소년의 문제행동 감소를위한 집단상담 효과의 메타분석. 계명대학교 교육학석사학위논문.
윤명숙, 김남희, 최혜정 (2013). 부모와 사별한대학생의 애도경험이 외상후 성장에 미치는 영향: 삶의 의미 매개효과 중심으로. 한국가족복지학회지, 39(3), 83-111.
윤운영, 유금란 (2013). 아동 및 청소년의 상실경험에 대한 이해와 학교상담의 개입. 한국심리학회지: 학교, 10(1), 241-262.
이윤주, 조계화, 이현지 (2007). 사별에 관한최근 연구동향 분석. 상담학연구, 8(3), 839-857.
이정숙 (2014). 친구와 사별한 초등학교 아동의 애도에 대한 게슈탈트 놀이치료. 한국놀이치료학회지, 17(1), 75-94.
임선영, 권석만 (2013). 역경후 성장에 영향을미치는 인지적 처리방략과 신념체계의 특성: 관계상실 경험자를 대상으로. 한국심리학회지: 임상, 32(3), 567-588.
조명숙 (2012). 외상적 사별 경험에 따른 병적애도 증상에서 의미만들기와 사건중심성의효과. 가톨릭대학교 박사학위논문.
차유림 (2012). 부모사별 이후 발생하는 부정적 생활사건이 청소년의 우울․불안에 미치는 영향: 영적 안녕감의 조절효과. 신앙과 학문, 17(2), 201-227.
최미희, 권지성 (2014). 청소년 자살 사후 학교중심 위기개입 프로그램에 대한 평가연구. 한국사회복지학회지, 66(1), 5-34.
최선재 (2011). 상실경험의 의미 재구성과 심리적 적응의 관계. 이화여자대학교 석사학위논문.
최선재, 안현의 (2013). 상실 경험의 의미 재구성과 심리적 적응의 관계. 상담학연구, 14(1), 323-341.
Achenbach, T. M. (1991). Manual for the Youth Self-Report Form and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.
Allen, B., Wilson, K. L., & Armstrong, N. E. (2014). Changing clinicians' beliefs about treatment for children experiencing trauma:The impact of intensive training in an evidence-based, trauma-focused treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 384-389.
Bisson, J., & Andrew, M. (2009). Psychological treatment of post-traumatic stress disorder(PTSD)(Review). The Cochrane Collaboration.
Boelen, P. A., Keijser, J. D., Hout, M. A., & Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Counseling and Clinical Psychology, 75(2), 277-284.
Brown, E. J., & Goodman, R. F. (2005). Childhood traumatic grief: An exploration of the construct in children bereaved on september 11. Journal of Clinical Child and Adolescents Psychology, 34, 248-259.
Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M., & Guthrie, R. (1999). Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. American Journal of Psychiatry, 156(11), 1780-1786.
Buhmann, C. (2014). Traumatized refugees:Morbidity, treatment and predictors of outcome. Danish Medical Journal, 61(8), 1-11.
Calhoun, L. G., & Tedeschi, R. G. (2013). Posttraumatic growth in clinical practice. New York, NY: Routledge.
Cheryl, R., & Tamara, S. (2004). Intersections between grief and trauma: Toward an empirically based model for treating traumatic grief. Brief Treatment and Crisis Intervention, 4(3), 289-309.
Cohen, J. A., & Mannarino, A. P. (2004). Treatment of childhood traumatic grief. Journal of Clinical Child and Adolescent Psychology, 33(4), 819-831.
Cohen, J. A., & Mannarino, A. P. (2008). Trauma-focused cognitive behavioral therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158-162.
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2004). Treating childhood traumatic grief: A pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 1225-1233.
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: One year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29, 135-145.
Cohen, J. A., Mannarino, A. P., & Staron, V. (2006). Modified cognitive behavioral therapy for childhood traumatic grief (CBT-CTG): A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1465-1473.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. NY: The Guilford Press.
Cohen, J. A., Berliner, L., & Mannarino, A. P. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems (Review). Child Abuse & Neglect, 34, 215-224.
Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2007). The effectiveness of bereavement interventions with children: A meta-analytic review of controlled outcome research. Journal of Clinical Child and Adolescent Psychology, 36(2), 253-259.
Deblinger, E., Pollio, E., & Dorsey, S. (2016). Applying trauma-focused cogntive-behavioral therapy in group format. Child Maltreatment, 21, 59-73.
Deblinger, E., Stauffer, L. B., & Steer, R. A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6, 332-343.
Faschingbauer, T., Zisook, S., & Devaul, R. (1987). The Texas Revised Inventory of Grief. In: Zisook, S. (Ed.), Biopsychosocial Aspects of Bereavement (p. 111-124). Washington D.C.: American Psychiatric Press.
Fiorini, J. J., & Mullen, J. A. (2014). 슬픔과 상실을 겪은 아동․청소년 상담 및 사례 (하정희 역). 서울: 학지사. (원저 2006년 출판)
Gil, E. (2010). Working with children to heal interpersonal trauma: The power of play. New York, NY: Guilford.
Gillies, D., Taylor, F., Gray, C., O'Brien, L., & D'Abrew, N. (2013). Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Evid-Based Child Health, 8(3), 1004-1116.
Gillies, J., & Neimeyer, R. A. (2006). Loss, grief, and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19, 31-65.
Glass, J. C. Jr. (1991). Death, loss and grief among middle school children: Implications for the school counselor. Elementary School Guidance and Counseling, 26(2), 139-149.
Granot, T. (2005). Without you: Children and young people growing up with loss and its effects. UK: Jessica Kingsley Publishers. Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6(4), 332-343.
Hendricks, A., Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2012). Dealing with trauma: A TF-CBT workbook for teens. (Unpublished manuscript).
Hogan, N. S., & Schmidt, L. A. (2002). Testing the grief to personal growth model using structural equation modeling. Death Studies, 26, 613-634.
Jones, A. M., Shealy, K. M., Quinones, K. R., Moreland, A. D., Davidson, T. M., Lopez, C. M., Barr, S. C., & Arellano, M. A. (2014). Guidelines for establishing a telemental health program to provide evidence-based therapy for trauma-exposed children and families. Psychological Services, 11(4), 398-409.
Konanur, S., Muller, R. T., Cinamon, J. S., Thornback, K., & Zorzella, K. P. (2015). Effectiveness of trauma-focused cognitive behavioral therapy in a community-based program. Child Abuse and Neglect, 50(12), 159.
Lang, J. M., Ford, J. D., & Fitzgerald, M. M. (2010). An algorithm for determining use of trauma-focused cognitive-behavioral therapy. Psychotherapy theory, Research, Practice, Training, 47(4), 554-569.
Layne, C. M., Pynoos, R. S., Saltzman, W. S., Arslanagic, B., Black, M., & Savjak, N. (2001). Trauma/grief-focused group psychotherapy: School-based post-war intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice, 5, 277-290.
Lenz, A. S., & Hollenbaugh, K. M. (2015). Meta-analysis of trauma-focused cognitive behavioral therapy for treating PTSD and co-occurring depression among children and adolescents. Counseling Outcome Research and Evaluation, 6(1), 18-32.
Little, S. G., Akin-Little, A., & Somerville, M. P. (2011). Response to trauma in child: An examination of effective intervention and post-traumatic growth. School Psychology International, 32(5), 448-463.
Mattocks, K. M., & Horwitz, R. I. (2000). Placebos, active control groups, and the unpredictability paradox. Society of Biological Psychaiatry, 47(8), 693-698.
Measham, T., Guzder, J., Roussezu, C., Pacione, L., Blais-McPherson, M., & Nadeau, L. (2014). Refugee children and their families:Supporting psychological well-being and positive adaptation following migration. Current Problems in Pediatric and Adolescent Health Care, 44(7), 208-215.
O'Callaghan, P., McMullen, B., Shannon, C., Rafferty, H., & Black, A. (2013). A randomized controlled trial of trauma-focused cognitive behavioral therapy for sexually exploited, war-affected congolese girls. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 359-369.
Piper, W. E., Ogrodniczuk, J. S., Joyce, A. S., Weideman, R., & Rosie, J. S. (2007). Group composition and group therapy for complicated grief. Journal of Consulting and Clinical Psychology, 75(1), 116-125.
Prendergast, M. L., Podus, D., Chang, E., & Urada, D. (2002). The effectiveness of drug abuse treatment: A meta-analysis of comparison group studies. Drug and Alcohol Dependence, 67(1), 53-72.
Prigerson, H. G., & Jacobs, S. C. (2001). Traumatic grief as a distinct disorder: A rationale, consensus criteria, and a preliminary empirical test. Handbook of bereavement research:Consequences, coping, and care. Washington, DC:American Psychological Association.
Saltzman, W. R., Pynoos, R. S., Layne, C. M., Steinberg, A. M., & Aisenberg, E. (2001). Trauma-and grief-focused intervention for adolescents exposed to community violence:Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research, and Practice, 5(4), 291-303.
Schoen, A. A., Burgoyne, M., & Schoen, S. F. (2004). Are the developmental needs of children in America adequately addressed during the grief process? Journal of Instructional Psychology, 31(2), 143-150.
Sofka, C. J. (1996). Loss History Checklist. In J. D. Mannino (Ed.), Grieving days, healing days (p. 20). Boston, MA: Allyn & Bacon.
Strobe, M., Schut, H., & Finkenauer, C. (2001). The traumatization of grief? A conceptual framework for understanding the traumabereavement interface. Journal of Psychiatry and Related Science, 38, 185-201.
Taku, K., Lawrence, G., Calhoun, A. C., & Richard, G. T. (2008). The role of rumination in the coexistence of distress and posttraumatic growth among bereavement Japanese university students. Death Studies, 32, 428-444.
Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455-471.
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundation and empirical evidence. Psychological Inquiry, 15, 93-102.
Thornback, K., & Muller, R. T. (2015). Relationships among emotion regulation and symptoms during trauma-focused CBT for school-aged children. Child Abuse and Neglect, 50, 182-192.
Webb, C., Hayes, A. M., Grasso, D., & Laurenceau, J. P. (2014). Trauma-Focused cognitive behavioral therapy for youth:Effectiveness in a community setting. Psychological Trauma: Theory, Research, Practice, and Policy, 6(5), 555-562.
Worden, J. W. (2007). 유족의 사별슬픔 상담과치료 (이범수 역). 서울: 도서출판 해조음. (원저 2002년 출판)
Yalom, I. D., & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy. New York, NY:Basic Books.
