走出憂鬱與恐慌，迎向陽光－－一位憂鬱症患者之護理經驗

Emerging from Depression and Panic Disorder into a Normal Life: A Case Report

本篇報告乃運用認知治療，於照護一位憂鬱症合併恐慌症患者之護理經驗分享。藉由觀察、會談及運用整體性護理評估等技巧收集資料，發現個案對自己或外在事件抱持負向的想法，長期深受憂鬱及恐慌發作症狀所苦，影響其個人及家庭生活。個案自入院後，筆者除了運用放鬆技巧減輕個案反覆換氣過度所造成之不適外，另外也發現憂鬱與焦慮的共同因素為負向的情緒，而此類患者常出現負向認知思考影響其情緒及行為反應。因此，與個案建立開放、信任的治療性關係，協助個案覺察確認其負向自動化思考，以及身體不適與缺乏解決問題之能力及技巧有關。透過個別的認知治療，使用家庭作業方式，訓練個案以正向思考替代負向自動化思考，協助矯正扭曲的認知。在措施執行後，發現個案憂鬱與焦慮情緒明顯改善並建立自我肯定的行為。降低恐慌發作之頻率，進而增加個人因應能力，回歸正常的社會生活。冀望此照護經驗，能提供護理同仁日後在面對照護類似個案之參考。

This study documents the nursing experience of caring for a patient with depression and panic disorder, using cognitive therapy. The subject had experienced chronic depression and repeated panic attacks for an extended period of time, which had a negative impact on both her and her family. In addition to applying relaxation techniques to alleviate discomfort resulting from repeated hyperventilation, the author also noted that negative emotion was the common cause of the subject's depression and anxiety. Such patients habitually experience negative cognition, which influences their emotions and behaviors. Plans were therefore developed to assist the subject in: (i) recognizing her negative automatic thoughts, (ii) realizing that her physical discomfort and lack of problem-solving skills were both related to such thoughts, and (iii) correcting cognitive distortion by substituting negative automatic thoughts with positive thoughts. Upon implementation of these plans, distinctly lessened depression and anxiety, and distinctly improved coping abilities were all noted. With panic attacks diminishing and individual coping abilities improved, a normal social life was again on the horizon for the subject. It is hoped that this study will be of use as a source of reference in the care of similar cases in the future.