運用認知行為治療於照顧一位反覆自傷之憂鬱症青少年的護理經驗

Cognitive Behavioral Therapy in the Care of a Repeatedly Self-Injurious Adolescent with Depression

本文探討一位青少年憂鬱症個案處遇多重壓力時，反覆自我傷害以作為因應方式，護理期間於2019年12月13日至2020年1月3日。照護期間以觀察、晤談和整體性評估工具收集資料，確立健康問題為：自我殘害、睡眠型態紊亂，及知識缺失等。於護理過程與個案及家屬建立良好護病關係，給予傾聽、同理心之關懷，並以實證護理維度發現認知行為治療效果，可矯正其思考路徑以及修正自我傷害之偏差行為，予以提供個案不同照護措施選擇，最終商討後採認知行為治療為主，經三週照護後，個案可嘗試改變自動化負向思考方式且採取適切因應自傷意念之方案，執治療期間，個案自傷行為次數實屬減少亦可積極主動完成約定內容，並達到良好行為發展。本次照護過程中，青少年屬於特殊且脆弱的族群，多因繁重的課業及家庭壓力，學校雖有輔導系統，但對於憂鬱症的青少年幫助有限，倘若能多一份關懷、支持或其他照護介入，則可降低其自殺的憾事產生，期望由此照護經驗可多面向提供不同學科領域人員作為臨床實務之參考，促使青少年返校就學之希望。

This article examines a case of an adolescent male with depression and repetitive self- injury as a response to multiple stressors during the period of care from December 13, 2019 to January 3, 2020. Observations, interviews, and a comprehensive assessment approach encompassing five crucial aspects were used to collect data during the care period to identify health problems such as self-mutilation, disturbed sleep pattern, and deficient knowledge. During the care process, we established a good care relationship with the patient and family members, provided supportive listening, empathic care, and discovered the effectiveness of cognitive behavioral therapy through empirical care dimensions to correct their thinking paths and self-injurious deviant behaviors. We further provided different choices of care measures following his own decision, and finally chose“cognitive behavioral therapy”. Three weeks into the care process, the instances of self-injurious behavior reduced, the patient was able to actively complete their appointments, and achieve good behavioral development during the treatment period. In this care process, adolescents are a special and fragile group, mostly due to heavy academic and family pressure; despite counseling systems in schools, which are of limited help to adolescents with depression. It is hoped that this case report can be used as reference in clinical practice across disciplines, and in turn raise the hope for young students to return to school.