運用認知行為治療於一位躁鬱症合併暴食症患者之護理經驗

The Application of Cognitive-behavior Therapy in a Bipolar 1 Disorder Patient with Bulimia Nervosa

本文主要描述一位23歲女性、診斷為「躁鬱症合併有暴食症」個案的護理經驗。照護期間2006年2月10日到95年3月16日。筆者藉由護理過程中運用會談及行為觀察的方式收集資料，評估個案身體、情緒、智能、社會、靈性等五大層面，發現個案有下列三項主要護理問題：（1）危險性自我傷害（2）營養狀況改變-少於身體需要（3）個人因應能力失調。個案於入院時呈現抗拒住院、自我傷害的行為及想法、暴飲暴食、對自己的身體心像呈現負面的看法、營養失衡等情形，筆者藉由建立穩定性的治療關係之後，建立有效的個人因應能力及支持系統；並介入認知行為治療使個案在面對壓力情境時，發現自己長期的認知扭曲，進而教導個案修正偏執負面之認知，使之以不危害健康的行為模式來抒解內心的壓力，並運用認知行為治療學習而來的自我肯定技巧降低暴食催吐之頻率，進而提昇自我效能及自我控制感，使個案更有信心調適生活壓力。This paper described the nursing experience of a 23 years-old female Bipolar I disorder patient with bulimia nervosa. The author collected data by applying conversation and observation and the patient was evaluated physically, emotionally, intellectually, socially and spiritually. The major nursing problems included: (1) Risk for self-mutilation, (2) Altered Nutrition: less than requirements, and (3) Ineffective individual coping. The patient presented refusal behavior, self-mutilation, too much eating and drinking, and unbalanced nutrition. After establishing a steady therapeutic relationship, the author set up an effective individual coping ability and supporting system. The author helped him to find the long-term distorted cognition by applying the cognitive-behavior therapy to the patient under pressure. Further, the author taught the client to correct the negative cognition and released pressure without self-multilation for the patient. Before the patient discharged from hospital, the vomit frequency of the patient was reduced with an assertive skill and it helped the patient to improve his self-control ability and self-efficacy toward a healthy life.