강박증에 대한 기독교 상담적 이해 (A Study on the Christian Counselling for Obsessive-Compulsive Disorder)

서지정보

· 발행기관 : 한국복음주의상담학회
· 수록지 정보 : 복음과 상담 / 22권 / 1호 / 290 ~ 322페이지
· 저자명 : 최민영, 이유니

초록

본 연구의 목적은 반복적이고 통제 불가능한 침투적 강박사고와 이로 인한 공포와 불안을 감소시키려고 강박행동에 몰두하는 내담자를 기독교 상담적인 관점에서 이해하고 치료한 단일사례를 소개함으로써 강박증을 가진 내담자가 고통스러운 강박의 굴레를 벗어나서 복음이 주는 참 자유를 회복할 수 있도록 돕는 한편, 강박증 내담자를 만나는 기독교 상담자들에게 강박증의 기독교 상담적 이해와 치료의 가능성을 제안하는데 있다.
이를 위해 연구자들은 첫째, 강박증의 선행연구들을 고찰하였다. 선행연구들은 주로 병인론 연구, 공존질환 연구, 치료 연구로 분류되었고 각각의 주제는 다시 생물학적 연구 영역과 인지행동치료 연구 영역으로 나뉘어져 있었다. 본 연구에서는 생물학적 영역을 제외한 인지행동치료 영역의 선행연구들을 살펴보았다.
그리고 나서 연구자들은 DSM-5에 분류된 강박사고와 강박행동의 성격과 종류, ‘강박증적 인지에 대한 작업집단이 제시한 6가지 인지적 개념 등을 소개했다. 나아가 종교와 관련이 있는 강박사고와 강박행동의 내용 및 그것과 관련된 인지적 개념 등도 함께 확인해 보았다. 네 번째로 강박증에 대한 치료로 가장 핵심적이라고 알려져 있는 노출-반응 방지 기법(ERP)과 내담자의 인지적 개념에 지속적으로 도전을 주는 인지적 재구조화 기법을 정리한 후 마지막으로 복음주의 기독교 상담 접근으로 강박증 치료를 시도한 단일사례를 소개했다.

영어초록

The purpose of this study is to help the obsessive-compulsive disorder(OCD) clients obtain the true freedom which the Gospel can give and set them free from a distressful yoke of obsessions and compulsions and to present a Christian coping plan to Christian counselors who will meet OCD clients by providing the Christian understanding of OCD and the possibility of Christian therapeutic application of OCD.
This study consists of five dimensions: a review of research literatures concernig OCD, a general overview and description of OCD, a summary of symptoms of religious OCD, introduction of a primary OCD treatment approach, and one case study in which one of the researchers treated an OCD client in a Christian manner.
Previous research is divided mostly into four parts. They are about OCD etiology, OCD comorbidity, OCD treatment approach and religious OCD. First, the definate etiology of OCD remains unknown yet. Some researchers study the etiology of OCD in neurobiological aspect and other researchers in psychological aspect. Concerning the comorbidity, OCD is reported to be comorbid with personality disorders including borderline personality disorders, avoidant personality disorders and histrionic personality disorders. Next, OCD treatment approach is divided into two areas. One is medications which play an important role in the treatment of OCD. The other OCD treatment is exposure-response prevention(ERP) which is psychological intervention which is best-tested. Lastly, research on religious OCD is done. Research examines primarily the relationship between OCD and religious faith and scrupulosity in OCD clients.
In second dimension, we present the general concept of OCD. OCD is defined in DSM-5 as obsessional thoughts and/or compulsive actions. “Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly”(DSM-5).
An international group of researchers proposed six domains of cognition relevant to current cognitive-behavioral formulations of OCD. They are inflated responsibility, overimportance of intrusive thoughts, overimportance of controlling one’s thoughts, overestimation of threat, intolerance of uncertainty and perfectionism.
OCD symptoms related to religion include intrusive blasphemous thoughts, obscenities related to religious figures, and thoughts about joining the devil and going to hell. Compulsions include repetitive prayer as a route to cope, seeking reassurance from others and treating religious symbols with excessive care.
As therapeutic techniques, we introduce ERP, the central treatment of Behavioral Therapy. ERP includes exposure exercises and response prevention. Exposure exercises involves real-life or imaginal contact with anxiety evoking stimuli. Response prevention encourages OCD clients to block or delay compulsive rituals after performing exposure exercises. Some cognitive strategies of Cognitive Therapy are mentioned very briefly as well.
Finally we add one case study, in which an OCD client is treated by applying ERP and Cogntive Therapy in a Christian way. He is taught that what he thinks is uncontrollable and intrusive, and he can’t do anything about it. He learns to refer responsibility of his thoughts to God. Instead of praying for forgiveness, he prays to know and experience God Himself.

참고자료

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