以辯證行為治療照顧一位反覆自傷青少年的護理經驗

Applying Dialectical Behavior Therapy in the Nursing Care for An Adolescent with Repeated Self-Harm

本文描述一位因缺乏情緒調適能力，面對負向情緒反覆自我傷害青少年個案之護理經驗。青少年時期的個案正處於生理心理急遽變化的轉銜期，增加臨床照護上的困難度，於照護過程如何提升個案的因應能力，更是刻不容緩的議題，故引發筆者的動機。護理期間為2021年3月20日至2021年5月15日，運用生理、心理、智能、社會及靈性五大層面護理評估，確立個案主要健康問題為高危險性自傷與社交互動障礙。在高危險性自傷照護過程中筆者以同理、傾聽及個別會談方式，引導個案表達自傷行為的想法，使用辯證行為治療（Dialectical behavior therapy, DBT）-正念、情緒調節、痛苦耐受、人際效能技巧為介入照護措施，以增強個案處理情緒和控制行為的能力，降低自我傷害行為；在社交互動障礙照護上，運用講解、示範、角色扮演、回饋與反覆練習之社交技巧訓練，協助個案發展合宜社交互動並提升自信心。希冀由探究反覆自傷青少年的照護內涵，除了改善個案情緒調適技巧、提升照護品質外，亦能藉由本文的整理及照護過程，進而加深護理人員對辯證行為理論的相關知能，做為未來照護此類個案之參考。

This article describes the nursing experience of caring for an adolescent who engaged in repeated self-harm due to negative emotions and a lack of emotional regulation skills. Adolescence is a transitional period marked by rapid physiological and psychological changes, which complicates clinical care. Addressing the issue of improving the patient's coping skills was crucial and required prompt attention. A comprehensive assessment—including physical, emotional, intellectual, social, and spiritual dimensions—was conducted to identify the main health problems from March 20, 2021, to May 15, 2021. The primary nursing issues identified were high-risk self-harm and social interaction barriers. To enhance the patient’s coping skills, the author applied dialectical behavior therapy ( DBT ), an integrated care model for addressing repeated self-harm. DBT focused on four key areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These approaches were designed to help the patient better manage emotions, control behaviors, and reduce self-harm. To boost self-confidence and develop appropriate social skills, social skills training was implemented. This training included explanations, demonstrations, role-playing, feedback, and repeated practice to address the patient's social interaction barriers. This article deepened our understanding of DBT and provided an individualized care experience, which can serve as a valuable reference for managing similar cases in the future.