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Title: 外展心理介入有心理症狀但未求助者的初探-以九二一災民為例
Authors: 吳勢鵬
Wu,Shih-Pon
Contributors: 許文耀
吳勢鵬
Wu,Shih-Pon
Keywords: 外展
心理介入
創傷壓力疾患
認知行為治療
發現取向
outreach
psychological intervetion
PTSD
CBT
discovery-oriented
Date: 2006
Issue Date: 2009-09-17 13:13:31 (UTC+8)
Abstract: 回顧地震災難心理學的相關研究指出,災難創傷所引起的心理壓力反應具有長期、慢性化的影響,然而許多有心理壓力反應症狀的民眾可能會因為精神疾病的污名化、社會文化的漠視或忽視、應付接踵而至的生活事件、或症狀引起的退縮行為等種種因素,而不願或未求助心理專業的協助,因此相關的研究同時也指出發展外展心理介入計劃的必要性;然而不論在實務或在研究方面,對有心理症狀但未求助的災民實施外展心理介入卻是鮮而少見的。<br> 本篇研究採用已獲多數研究證實有效治療創傷壓力疾患(Posttraumatic Stress Disorder, PTSD)的認知行為治療(Cognitive-Behavioral Therapy, CBT),做為對有症狀但未求助的九二一災民外展心理介入的工作架構,再透過發現取向(discovery-oriented)的研究方法,整理分析介入訪談的資料,以獲得外展心理介入歷程的發現與探討。
<br>整理、分析研究資料發現:災民容易因為災後接踵而至的生活變動或退縮而無法求助心理專業,災民因為地震後引發早期適應不良基模和外在聚焦的因應型態,以致無法覺察沒有求助或造成心理症狀慢性化,此與吳英璋(2000)所論及性格特質與災後處遇因素影響災後心理反應是一致的。外展心理介入以持續、密集的方式與災民建立適當的工作關係,改變災民對人負向的基本信念,讓災民有更深入的敘述與自我覺察,其次在貼近災民的日常生活脈絡中,從日常生活事件反覆地分析與練習,才足以動搖既有的信念與行為反應,使災民對事件產生內在聚焦的因應來增加自我效能和控制感,並且從災民置身所在的環境脈絡裡處理創傷個案的經驗迴避問題。以CBT做為外展心理介入的架構進行介入,比較無法使用家庭作業讓個案學習與練習,需透過個案所及能說的日常生活事件中,對其內在經驗聚焦、反覆辯證以致增加個案正向經驗、辨識刺激控制、以及思考的辨證,使個案增加自我效能、控制感、自我肯定等,以達到增加個人資源與賦權之目的。
There are lots of studies about disaster psychology related earthquakes presenting long-term chronically influence to psychological reactions, and implicating the importance of outreach intervention programs for non-seeking people with traumatic psychological reactions or posttraumatic stress disorder(PTSD). The people might not get help from professionals because stigmatization, apathy or ignore of society, business on going daily events, or withdrawal symptoms. So far as, neither even practicing nor research, there is few article about outreach intervention program for the people with psychological symptoms but non-seeking help. This study applies the framework of cognitive-behavioral therapy(CBT) verified by a lot of studies and practice for PTSD, and uses the discovery-oriented research, to discover and gain the understandings of outreach psychological intervention to non-seeking help people with psychological stress reactions in 921 earthquake. The result finds that people with psychological stress reactions mostly accompany with continuously daily event and withdrawal symptoms to seek help. The early maladaptive schemas invoked by earthquake and the external focus make people difficult to aware the need for help and chronically, and this finding is consistent with the discussion of the psychological reactions influenced by personality trait and disaster management in Wu (2000). Outreach psychological intervention established the working relationship through continuously, condensed schedule changing their negative belief to people, and having them deeper narrative and self-awareness. Secondary, by closed their contextual daily life and repeated exercises by daily event, such impacts are enough to shake their steadily believes and habituated behavioral reactions, then to have people internal focus and increase self-efficacy and controllability; further management is contextual analysis and treatment of experiential avoidance in the ecological context of daily life. The outreach psychological intervention by the framework of cognitive-behavioral therapy, it is difficult to apply homework assignment as review or exercise between sessions; and for regaining personal resource and empowerment, outreach psychological intervention mostly applies internal focus and repeated dialectical discussion to increase positive experience, discriminate of stimulus control, and dialectical thinking, and finally people have more self-efficacy, controllability, and self-assertiveness.
Reference: 王文華(2005)。行動研究法在教育行政上的應用。學校行政雙月刊,37,81-95。
吳英璋(2000)。心理的復(重)建與心靈的復(重)建。九二一震災心理復建學術研討會論文集。台北市:教育部學生輔導支援中心。
吳英璋(2001)。從臨床心理學觀點看重建區居民的心理狀況。社區醫療通訊,8。台大醫學院社區醫學研究群,院內九二一相關期刊。http://www.mc.ntu.edu.tw/department/cmrg/921paper/08-04paper.htm
李美枝(2003)。理性與感性:人的雙重面。應用心理研究,17,1-5。
李維倫(1995)。本土心理學必須超越「心理實體論」。本土心理學研究,4,367-379。
汪文聖(2002)。科技化精神疾病醫療的現象學意義回溯-對實徵科學的量性與質性研究法的哲學反思。行政院國家科學委員會輔助專題研究計畫(計畫編號:NSC 91-2411-H-004-005)。
林本堂、呂明憲、陳展航(2003)。集集大地震受災國中學生及家長壓力反應和求助行為之探討。台灣精神醫學,17(4),263-268。
林昌億、黃敏偉、周煌智、歐陽文貞、蔡東杰、陳明招(2004)。大地震倖存者罹患精神疾病接受居家治療的預後與生活品質之追蹤。中台灣醫誌,9,增刊,s9-s15。
林耀盛(2000a)。地震之後,千禧之始:重探心理學與諮商學的共構關係。應用心理研究,5,165-193。
林耀盛(2000b)。創傷、復健與置身所在:再論現代心理學處境,兼回應李維倫教授。應用心理研究,6,54-65。
夏林清(1999)。制度變革中教育實踐的空間:一個行動研究的實例與概念。應用心理研究,1,33-68。
許文耀(2000)。九二一地震災區學生的因應型態與心理症狀的關係。中華心理衛生學刊,13(3),35-59。
許文耀(2004)。從資源變化歷程及影響因子觀點探討災難對人們心理狀況的變與不變(III)。行政院國家科學委員會輔助專題研究計畫(報告編號:NSC 29-2625-Z-004-001)。
許文耀、曾幼涵(2003)。九二一地震後災民的資源變化與心理症狀間的關係。中華心理衛生學刊,16(2),1-19。
陳淑惠、林耀盛、洪福建、曾旭民(2000)。九二一震災受創者社會心理反應之分析-兼論「變」與「不變」間的心理社會意涵。中央大學社會文化學報,10,35-60。
陶蕃瀛(2004)。行動研究:一種增強權能的助人工作方法。應用心理研究,23,33-48。
楊瑞珍、陳美燕、黃璉華(2001)。行動研究法的概念及其在護理的應用。醫護科技學刊,3(3),244-254。
楊聰財、李明濱(2004)。九二一集集大地震災後精神疾病研究論文之分析。台灣醫學,8(3),301-312。
鄭增財(2003)。批判理論與行動研究。商業職業教育,89,47-55。
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington, DC: American Psychiatric Association.
Basoglu, M., Kilic, C., Salcioglu, E., & Livanou, M. (2004). Prevalence of posttraumatic stress disorder and comorbid depression in earthquake survivors in Turkey: An epidemiological study[Abstract]. Journal of Traumatic Stress, 17(2), 133-141.
Blagys, M. D., & Hilsenroth, M. J. (2002). Distinctive activities of cognitive-behavioral therapy: A review of the comparative psychotherapy process literature. Clinical Psychology Review, 22, 671-706.
Blake, D. D., & Sonnenberg, R. T. (1998). Outcome research on behavioral and cognitive-behavioral treatments for trauma survivors. In V. M. Follette, J. I. Ruzek, & F. R. Abueg (Eds.). Cognitive-behavioral therapy for trauma (pp. 15-17). New York: Guilford Press.
Breadley, R., Green, J., Russ, E., Dutra, L., & Western, D. (2005). A multidimentional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry, 162(2), 214-227.
Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339-376.
Calhoun, L. G., & Tedeschi, R. G. (1998). Beyond recovery from trauma: Implications for clinical practice and research. Journal of Social Issue, 54, 357-371.
Eells, T. D. (1997). Psychotherapy case formulation: history and current status. In T. D. Eells (Ed.). Handbook of psychotherapy case formulation (pp. 1-25). New York: Guilford Press.
Ehlers, A., & Clark, D. M. (2000). A model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.
Ehlers, A., & Clark, D. M. (2003). Early psychological intervention for adult survivors of trauma: A review. Biological Psychiatry, 53, 817-826.
Erdur, O. (2004). Psychological reactions of Turkish earthquake survivors.Unpublished doctoral dissertation, the University of Texas at Austin.
Foa, E. B., Molnar, C., & Cashman, L. (1995). Change in rape narratives during exposure therapy for PTSD. Journal of Traumatic Stress, 8, 675-690.
Foa, E. B., Steketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualization of posttraumatic stress disorder. Behavior Therapy, 20, 155-176.
Follette, V. M., Palm, K. M., & Hall, M. L. R. (2004). Acceptance, mindfulness, and trauma. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 192-208). New York: Guilford Press.
Follette, V. M., Ruzek, J. I., & Abueg, F. R. (1998). A contextual analysis of trauma: theoretical considerations. In V. M. Follette, J. I. Ruzek, & F. R. Abueg (Eds.), Cognitive-behavioral therapies for trauma (pp. 3-14). New York: Guilford Press.
Forsyth, D. R., & Strong, S. R. (1986). The scientific study of counseling and psychotherapy: a unificationist view. American Psychologist, 41(2), 113-119.
Goenjian, A. K., Steinberg, A. M. Najarian, L. M., Fairbanks, L. A., Tashjian, M., & Pynoos, R. S. (2000). Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. American Journal of Psychiatry, 157(6), 911-916.
Goldfried, M. R. (2003). Cognitive-behavior therapy: Reflections on the evolution of a therapeutic orientation. Cognitive Therapy and Research, 27(1), 53-69.
Greenberg, L. S. & Newman, F. L. (1996). An approach to psychotherapy change process research: introduction to the special section. Journal of Consulting and Clinical Psychology, 54(3), 435-438.
Greenberg, L. S. (1986). Change process research. Journal of Consulting and Clinical Psychology, 54(1), 4-9.
Grinage, B. D. (2003). Diagnosis and management of post-traumatic stress disorder. American Family Physician, 68(12), 2041-2048.
Harvey, A. G., Bryant, R. A., & Tarrier, N. (2003). Cognitive behaviour therapy for posttraumatic stress disorder. Clinical Psychology Review, 23, 501-522.
Hayes, S. C., Follette, W. C., & Follette, V. M. (1995). Behavior therapy: A contextual approach. In A. S. Gurman & S. B. Messer (Eds.), Essential psychotherapies: Theory and practice (pp.128-181). New York: Guilford Press.
Herman, J. L. (1992). Trauma and recovery. New York: Basic Book.
Hill, C. E. (1990). Exploration in-session process research in individual psychotherapy: a review. Journal of Consulting and Clinical Psychology, 58(13), 288-194.
Jacobson, N. S., Schmailing, K. B., Holtzworth-Munroe, A., Katt, J. L., Wood, L. F., & Follette, V. M. (1989). Research-structured vs. clinically flexible version of social learning-based material therapy. Behaviour Research and Therapy, 27, 173-180.
Jia, F., Yang, D., Wang, X., Zhang, B., Xue, G.. M., Men, X. M. et al. (1999). Results of the MMPI of those paralyzed in the Tangshan earthquake 21 years later[Abstract]. Chinese Mental Health Journal, 13(5), 297.
Jordan, K. (2001). Working with trauma survivors with PTSD: An overview of assessment, diagnosis, and treatment. Counseling and Human Development, 34(1), 1-12.
Kanfer, F. H. (1985). Target selection for clinical change programs. Behavioral Assessment, 7, 7-20.
KiliA, C., & Ulusoy, M. (2003). Psychological effects of the November 1999 earthquake in Turkey: An epidemiological study. Acta Psychiatrica Scandinavica, 108(3), 232-238.
Klass, C. S. (1996). Home visiting: Promoting healthy parent and child development. Baltimore, Md.: P.H. Brookes Pub. Co.
Kou, C. J., Tang, H. S., Tsay, C. J., Lin, S. K., Hu, W. H., & Chen, C. C. (2003). Prevalence of psychiatric disorders among bereaved survivors of a disastrous earthquake in Taiwan. Psychiatric Services, 54(2), 249-251.
Lai, T. J., Chang, C. M., Connor, K., Lee, L. C., & Davidson, J. (2004). Full and partial PTSD among earthquake survivors in rural Taiwan. Journal of Psychiatric Research, 38(3), 313-322.
Lewis, J. A., Lewis, M. D., Daniel, J. A., & D’Andrea, M. J. (2003). Community counseling empowerment: strategies for a diverse society. Pacific Grove, CA: Brook/Cole.
Linehen, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
Mahrer, A. R. (1988). Discovery-oriented psychotherapy research: rationale, aims, and methods. American Psychologist, 43(9), 694-702.
Mahrer, A. R., & Boulet, D. B. (1999). How to do discovery-oriented psychotherapy research. Journal of Clinical Psychology, 55(12), 1481-1493.
McFall, M., Malte, C., Fontana, A., & Rosenheck, R. A. (2000). Effects of an outreach intervention on use of mental health services by veterans with posttraumatic stress disorder. Psychiatric Services, 51(3), 369-374.
Meichenbaum, D., & Fong, G. (1993). How individuals control their own minds: A constructive narrative perspective. In D. M. Wegner & J. W. Pennebaker (Eds.), Handbook of mental control (pp. 473-489). New York: Prentice-Hall.
Miller, L. (2002). Psychological intervention for terroristic trauma: Symptoms, syndromes, and treatment strategies. Psychotherapy: Theory, Research, Practice, Training, 39(4), 283-296.
Mowrer, O. H. (1960). Learning theory and behaviors. New York: Wiley.
Myers, D. (1994). Outreach services following disaster. In Diane Myers (Ed.), Disaster and response and recovery: A handbook for mental health professionals. U.S. Department of Health & Human Service, Public Health Service, Substance Abuse and Mental Health Service Administration, Center for Mental Health Service. (陳錦宏等人譯。台北市:心靈工坊文化。)
Norris F. H., & Kaniasty, K. (1996). Received and perceived social support in times of stress: A test of social support deterioration deterrence model. Journal of Personality and social Psychology, 71, 498-511.
Norris, F. H., Kaniasty, K., & Scheer, D. A. (1990). Use of mental health service among victims of crime: frequency, correlates, and subsequent recovery. Journal of Consulting and Clinical Psychology, 58(5), 538-547.
Persons, J. B., & Tompkins, M. A. (1997). Cognitive-behavioral case formulation. In T. D. Eells (Ed), Handbook of psychotherapy case formulation (pp. 314-339). New York: Guilford Press.
Persons, J. B. (2005). Empiricism, mechanism, and the practice of cognitive-behavior therapy. Behavior Therapy, 36, 107-118.
Rappaport, J., & Seidman, E. (2000). Handbook of Community Psychology. New York: Kluwer Academic/Plenum Publishers.
Resick, P. A., & Calhoun, K. S. (2001). Posttraumatic stress disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (3rd ed.) (pp. 60-113). New York: Guilford Press.
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748-756.
Salcioglu, E., Basoglu, M., & Livanou, M. (2003). Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey[Abstract]. Journal of Nervous and Mental Disease, 191(3), 154-160.
Steel, K., & Tjassing, H. (1994). Health care moves to the home. World Heath, 47(4), 6-7.
Stiles, W. B., Shaprio, D. A., & Elliott, R. (1986). ‘Are all psychotherapies equivalent?’ American Psychologist, 41(2), 165-180.
Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oak, CA, USA: Sage Publications, Inc.
Thomé, B., Dykes, A-K., & Hallberg, I. R. (2003). Home care with regard to definition, care recipients, content and outcome: systematic literature review. Journal of Clinical Nursing, 12, 860-872.
VandenBos, G. R. (1986). Psychotherapy research: a special issue. American Psychologist, 41(2), 111-112.
Wagner, A. W., & Linehan, M. M. (1998). Dissociative behavior. In V. M. Follette, J. I. Ruzek, & F. R. Abueg (Eds.), Cognitive-behavioral therapy for trauma (pp. 191-225). New York: Guilford Press.
Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach (3rd ed.). Sarasota, FL: Professional Resource Press.
Young, J. E., Weinberger, A. D., & Beck, A. T. (2001). Cognitive Therapy for Depression. In David H. Barlow (Ed.), Clinical handbook of psychological disorders: a step-by-step treatment manual (3rd ed.). New York: Guilford Press
Description: 碩士
國立政治大學
心理學研究所
90752021
95
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Data Type: thesis
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