사회공포증 집단치료 ㅡ치료경과 및 결과 一

Group Therapy of Social Phobia - Process and Results -

This report is on the process and results of Group therapy for social phobics, practiced at Koryo General Hospital from O c t, 1983 to June, 1986. Initial two groups did not proceed well mainly due to high drop-out ratio (1st group; 70%, 2nd group: 62%) as reported previously. Through these empirical trials a more systematized treatment plan was established, which emphasized careful patient selection, sufficient pretreatment interviews (three times), full payment of fee before the treatment started to lower drop-out ratio. Essential principles and processes of group therapy are as follows; 1) The basic hypothesis is that the key problem in social phobics is their distorted cognitions about their symptoms. The patients regard normal interpersonal reactions like blushing, trembling as prthological, abnormal defect unique to themselves. 2) Therefore, the main therapeutic goal is cognitive reconstructuring aimed at changing the patient s attitude toward their social phobic symptoms from the unreasonable, the negative to the reasonable, the positive. 3) The therapeutic process consists of eight weeks of weekly sessions with four follow-up sessions during 10 months. a) Weekly therapy (1) 1st Step (1.2.3 Session): Stage of acquiring intellectual insight from understanding of cultural background. (2) 2nd Step (4.5.6 Session): Stage of acquiring experiential in s is t in the in vivo situation. (3) 3rd Step (7.8 Session): Stage of accepting their symptoms rationally and positively. b) Followᅭup (On the 1st, 3,6 and 10th month after completion of the weekly therapy): stage of applying acquired insight to real life situation. According to this schedule, six groups of 79 patients (male 46, female 33) have completed the full one year course. The results were satisfactory as follows; 2) Eight patients (10.1%) dropped out during the eight weeks therapy session. The follow-up drop- -out ratio was 36.7%. 2) Patients, self-report on a five—point scale on the incidence of three most troublesome symptoms (0: none-4: always) and the degree of impairment by them (0 : none-4: pathological) decreased from 3.6, 3.6 before the treatment to 2.1, 2.1 after eight weeks therapy followed by a slight decrement through the follow-up. Relationships between therapeutic effectiveness and various factors are: (1) More effective in the group with strong group-cohesion. (2) sli^itly more effective in male. (3) Slightly more effective in delusional type than simple type, and poor in borderline type. (4) Poor in the cases of symptoms evoked by psychological trauma. (5) No difference in the duration of symptoms. (6) No difference among the types of symptom. 3) Almost of all patients except borderline types recovered to their normal social life. Combination of individual therapy, treatment of borderline types, establishment of more objective reliable assessment method, more convenient therapeutic comditions and drug therapy were regarded as the tasks for better results.