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Korean Journal of Clinical Psychology

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E-ISSN : 2733-4538

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29권 1호

사회 공포증 하위 유형 분류에서의 대인관계 문제적 접근: 임상 특징 및 치료 효과를 중심으로

Clinical Characteristics and Treatment Responses of Social Phobia Subtypes Based on Interpersonal Problem Patterns

윤혜영 (고려대학교)
권정혜 (고려대학교)
Korean Journal of Clinical Psychology / Korean Journal of Clinical Psychology, (E)2733-4538
2010, v.29 no.1, pp.259-284
https://doi.org/10.15842/kjcp.2010.29.1.015
윤혜영, & 권정혜. (2010). 사회 공포증 하위 유형 분류에서의 대인관계 문제적 접근: 임상 특징 및 치료 효과를 중심으로. Korean Journal of Clinical Psychology, 29(1), 259-284, https://doi.org/10.15842/kjcp.2010.29.1.015

초록

본 연구에서는 DSM-IV에 근거한 사회 공포증의 하위 유형 구분인 일반화 유형과 비일반화 유형이 증상 심각도의 양적 차이만을 반영할 수 있다고 보아, 사회 공포증 내담자에게서 나타나는 질적 차이를 대인관계 유형을 통해 살펴보고자 하였다. 이를 위하여 사회 공포증 내담자들의 이질적인 대인관계 특성에 근거하여 질적으로 구분되는 하위 유형을 분류한 후, 이러한 분류가 DSM-IV의 하위 유형과 구별되는 부가적 정보를 제공하는지 알아보았다. 구조화된 면접을 통해 사회 공포증으로 진단받고 8주간의 사회 공포증 인지 행동 치료를 받은 74명을 대상으로 한국판 대인관계 문제 검사(KIIP) 자료를 수집하였다. Leary(1957)가 제안한 대인관계 원형 모델에 입각하여 KIIP의 편차 점수를 군집 분석한 후 내담자 집단을 ‘지배형-통제/ 자기중심성 유형(n=14)’, ‘굴종형-비주장/ 사회적 억제 유형(n=60)’으로 구분하였으며, 두 집단의 임상적 특성과 치료 반응성을 비교하였다. 이를 위해 자기 보고식 척도로는 사회적 회피 및 불편감 척도(SADS), 부정적 평가에 대한 두려움 척도(B-FNE), 사회적 상호 작용 불안 척도(SIAS), 사회 공포증 척도(SPS)를 이용하였으며, 보다 객관적인 평가를 위해서 치료 전후의 즉흥 연설 시간과 주관적 불편감 점수, 임상가의 전반적 인상 평가(CGI)를 측정하였다. DSM-IV 진단적 정의에 근거해서 사회 공포증 하위 유형을 분류했을 때, 일반형 집단(GSP)의 대인관계 문제나 증상 심각도가 더욱 심각한 것으로 나타났다. 대인관계 문제를 근거로 사회 공포증의 하위 유형을 군집 분석했을 때, 지배형과 굴종형 집단의 전반적인 임상적인 특성에서는 뚜렷한 차이가 관찰되지 않았으며, 8회기 동안의 인지 행동 치료에도 대부분 동등한 수준의 효과를 거두는 것으로 나타났다. 그러나 굴종형 집단에 비해 지배형 집단의 경우 사회적 상황에 대한 회피 수준이 인지 치료를 통해 더 유의하게 감소하는 것으로 나타났다. 대인관계 문제 유형에 근거한 하위 유형 구분의 의의와 한계에 대해서 논의하였다.

keywords
사회 공포증 하위 유형, 대인관계 문제, 임상 특징, 치료 반응, social phobia subtype, interpersonal problem, characteristic, treatment response

Abstract

This study aimed to determine whether individuals with social phobia (SP) could be classified into subtypes according to their interpersonal problem patterns and to discover whether such different subtypes would respond differently to cognitive -behavioral therapy. We used the Korean Inventory of Interpersonal Problems (KIIP-C), Anxiety Disorder Interview Schedule-IV (ADIS-IV), and Self-Reported Test Battery (Korean version of Social Avoidance and Distress Scale; SADS, Brief-Fear of negative Evaluation Scale; B-FNE, Social Interaction Anxiety Scale; SIAS, Social Phobia Scale; SPS) to assess 74 SP patients who participated in eight-weeks of cognitive-behavioral therapy and we examined the participants' behavior patterns as recorded before -and -after the therapy for the treatment's effects. According to our cluster analysis of T-scores of KIIP-C variations, Participants fell into two different classifications: dominant type (n = 14), and submissive type (n = 60). Comparing their different characteristics and responses to treatment, we found the generalized social phobia group reported greater symptom severity and suffered more interpersonal problems than did the non-generalized social phobia group. When examined via interpersonal subtype classification, the two subgroups shared similar symptom severity and treatment responses patterns. With regard to social avoidance, dominant-type SP patients improved significantly more than did submissive type patients. We discussed the implications and potential clinical relevance of social phobia classification based on interpersonal problem patterns.

keywords
사회 공포증 하위 유형, 대인관계 문제, 임상 특징, 치료 반응, social phobia subtype, interpersonal problem, characteristic, treatment response

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