運用認知行為治療於酒精依賴合併重度憂鬱症個案之護理經驗

Nursing Experience of Using Cognitive Behavior Therapy for an Alcohol Dependent Combining with Major Depression Disordered Patient

本文旨在說明運用認知行為治療協助一位酒精依賴合併重度憂鬱症個案的護理經驗。護理期間自2004年12月27日至2005年1月25日。筆者根據身體、情緒、智能、社會、靈性等五大層面評估，發現個案的護理問題為：1.個人調適能力失調；2.長期性低自尊；3.睡眠型態紊亂。在護理過程運用認知行為治療中之思考、感受、表現行為及自我探索的練習、密切觀察自己、並加以記錄自我感受等認知重建方式後，個案能重建自信心，面對壓力，拒絕酒精的誘惑，並能重新回到工作崗位上。個案雖然四個月後再次因為心情低落與酗酒問題入院，但較過去個案平均每兩個月即入院治療一次，且文獻顯示酒癮患者重複住院率約為3個月，顯示出認知治療對個案仍具有正面之療效。希望藉由本篇個案報告之經驗分享，能提供護理人員日後在面對酒精依賴合併重度憂鬱症病患照護時能有更多的參考依據。

The case report described the nursing experience of using cognitive behavior therapy for caring an alcohol dependent combining with major depressive disordered patient. The patient was evaluated physically, emotionally, intellectually, and socially and spiritually. The major nursing problems included: (1) adaptive ability disorder, (2) long term low self-esteem, and (3) sleep pattern disturbance. During the nursing period of using cognitive behavior therapy, cognitive reestablishment process included exercises of thinking, perception, behavior performance, and self-discovery. Subject closely observed himself and recorded perception about himself to reestablish self-confidence, face stress, refuse alcohol, and return to work. Although 4 months later, the patient returned to the hospital again because of mood depression and alcohol drinking problem, the frequency was much better than what he has experienced before treatment. In addition, literature has shown that alcoholism dependence reoccurred in about 3 month. The finding of this experience suggested the positive effect of cognitive behavior therapy for caring alcohol dependent combining with major depression disordered patients.