신경성 폭식증 성인에 대한 인지행동음악치료 사례연구

Abstract

본 연구자는 신경성폭식증 환자에게 인지행동 음악치료를 우리나라 실정에 맞추어 적용함으로 환자들의 폭식행동과 보상행동의 제거가 이루어지는 지를 탐구하고자 한다. 더불어 부가적인 효과로 자기효능감, 완벽주의적인 성향, 부적정서 등에서의 변화를 탐구하고, 인지적 왜곡에 영향을 미치는 음악치료기법에 대해서 살펴봄으로 이에 대한 효과성과 유용성을 알아보고자 하였다. 본 연구는 서울시에 위치한 Y신경정신과에서 신경성폭식증 진단을 받은 성인여성을 대상으로 9회의 인지행동음악치료를 개인회기로 실시하였으며, 사전2회와 사후 2회기의 음악치료의 처치가 없는 가운데 폭식행동에 대한 기초선 측정을 실시하였다. 분석은 양적분석과 질적분석으로 이분화되어 있다. 양적분석은 신경성 폭식증 여성의 폭식행동에 대한 ABA분석이며, 신경성 폭식증의 신체변화· 자아역기능적 특징(자기효능감, 다차원적 완벽주의 척도), 정서질문지를 측정하여 사전사후의 변화를 문항별로 살펴보았다. 질적분석은 단일사례의 연구의 제한점을 보완하기 위해 비디오 자료를 토대로 현상학적 분석을 실시하였다 연구결과 내담자는 프로그램을 실시하기 전의 기초선보다 폭식행동과 보상행동에 대한 빈도, 자기조절감, 체중에서 기초선이 상승하였다. 또한 폭식증 검사와 섭식태도검사 중 폭식행동 항목에서 각각 23%와 59%의 상승을 보였다. 둘째, 인지행동음악치료를 실시하기 전보다 부정적인 신체상 지각, 자아역기능적인 특징, 부정적인 정서가 감소하였다. 또 각 단계에서 활용된 인지행동음악치료기법은 내담자의 인지적 왜곡과 행동패턴을 수정하는데 있어 질적인 변화를 유도하였다. 결국 인지행동음악치료는 인지적 왜곡과 파괴적인 행동패턴에 도전하는 동안 위협받지 않고 지지적인 환경을 제공하여 인지행동치료의 한계를 효과적으로 보완할 수 있었다. 내담자는 인지행동음악치료를 통해 폭식행동의 감소 뿐 아니라 자기조절감. 자기효능감, 완벽주의적 특정, 정서부분에서 긍정적인 변화를 보임으로 성공적인 치료결과를 얻을 수 있었다.;Binge eating in the eating disorder that the one eats much more than most people in a similar situation and fixed and that the one loses the regulating ability. Bulimia nervosa is an eating disorder characterizd by a reporeted pattern of uncontrolled episodic binge eating followed by negative mood and self-blame thought. they are associated psychological problems such as low self-efficacy, body dissatisfication, negative affect like depression and anxiety. There have been methods of treatment researches, cognitive behavioral therapy has been known to be the most effective method among psychological and behavioral therapies. However, this cognitive behavior therapy can cause a strong resistance in the early establishment of therapeutic relationship with patients suffering from bulimia nervosa accompanied with perfectionism, low self-efficacy, and negative emotion. Moreover, self-efficacy can get low in the process of treating it using the therapy. Music is used as a mechanism to overcome such a limitation of cognitive behavior therapy. Thus, this researcher purposed to examine whether binge-eating behavior and compensatory behavior could be removed when cognitive behavior therapy using music would be applied to patients with bulimia nervosa in accordance with Korean situations. Examination was also made on changes in self-efficacy, perfectionism inclination, and negative emotion as its additional effects, and a music therapeutic technique which affects cognitive distortion was investigated to identify its effectiveness and usefulness. Aiming at adult females whose case was diagnosed as bulimia nervosa in Y Neuropsychiatry in Seoul, this study conducted cognitive behavior therapy using music nine times individually. The baseline of binge-eating behavior was measured while pre-session and post-session without music therapy were carried out 2 times respectively. To analyze these data, qualitative analysis and quantitative analysis were done. With regard to qualitative analysis, ABA analysis was done on binge-eating behavior of females with bulimia nervosa, and change in body, dysfunctional characteristics(self-efficacy, multidimensional perfectionism scale), and questionnaire inventory were analyzed to examine changes between pre-therapy and post-therapy by items. For quantitative analysis, phenomenological analysis was carried out based on video data to supplement limitations in single-case study. The result of this study showed that the baseline of clients was increased in frequency of binge-eating behavior and self-control, and weight after conducting the program. In addephagia test and dietary attitude test, furthermore, the baseline of binge-eating behavior was increased by 23% and 59% respectively. Second, after conducting cognitive behavior therapy using music, negative perception of body, dysfunctional characteristics, and negative emotions were decreased. Cognitive behavior therapy using music applied in each item induced qualitative changes in clients' correcting cognitive distortion and behavior patterns. After all, cognitive behavior therapy using music could supplement the limitation of cognitive behavior therapy while challenging cognitive distortion and destructive behavior patterns by providing supportive environment without any threat. Through cognitive behavior therapy using music, clients could obtain successful results showing positive changes in self-control, self-efficacy, perfectionism characteristics, and emotions as well as reducing frequency of binge-eating behavior.