BCMローテーションも今週で終わり
金曜午前は、予定が入らなかったので「認知行動療法」を学びたいと希望をしたところ
あいにくちょうど良いセッションがスケジュールされておらず
家庭医プログラム専属のpsychologistが
午前中いっぱいマンツーマンでレクチャーしてくれることに
なぜ「認知行動療法」を希望したかと言えば
日本でのこれまでの経験から
うつ病、パニック障害などの治療には、
長期的にみれば抗うつ剤単独よりも、認知行動療法単独もしくは抗うつ剤との併用の方が成績が良いことが分かっているにもかかわらず
「認知行動療法」をしている施設が限られ
紹介するにもできず、困っていました
自分でやってみようかと、独学で勉強するも
書籍例：いやな気分よ、さようならー自分で学ぶ「抑うつ」克服法
実際、10-15分の外来ではどうしたら良いかも分からず
結局SSRIを出しておしまいというのが日本での状況でした
そんな状況から「10-15分でできるミニ認知行動療法は無いのか？」というのが私の問い
そこで認知行動療法の概要から始まり
認知療法、行動療法を
うつ病、パニック障害、OCD、GADに対して
どのようにapplyするかという実践的な話をしました
以下は自分のためのまとめ
リラクゼーションのために作ったMP3の録音もいただきました
----------------------------------------------------------
CBT vs 精神分析
CBTはwhyではなくHowにfocus
Cognitive
dysfunctional thought
Events(trigger) ---> reaction
Behavior
1. Event(A) ----> reaction -----> Event (B) +reinforcement
then Event(A) ----> reaction (w/o Event B)
2. Event (A)
Event (B) --------> reaction
then Event (B) --------> reaction
Depression
Beck Depression Inventory is useful
" I am always ........." <-----
"If I whisper in your ear as such all day long, how will you feel?"
"Is that really true?"
1. Observe yourself carefully, think of yourself like a spy. Write just down in sentence, what you think, feel.
2. How strong do you believe? 0-100% scale?
3. Break through the pattern
Put the thought in trial
True-- Why true? List 3-5 examples
Exeptions -- What exception
Usually, pt may not list any exception. then ask "Anybody else w .......?(put other people)"
"Other reason that .....?"
"Have you had same situation before......, how did you feel?"
Key: Challenge the thought, do not say "destroy, cancel the thought"
Always put both sides
4. Then ask again
"How strong do you believe? 0-100% scale?"
5. Let them do dozens of times.
Behavior therapy
Like PT, expand psychological ROM, gradually
Only ask easy things they can do by sure, at least, over 80%
1. Ask to do easy, fun things. "just go out 5min/week"
Usually, they are not joyful for a while, so say
"Put seeds before, get express" "fake it until you make it"
"prime the pomp" "do this because it is good for you, I can reassure"
2. "what does depression tells you to do? write down. "
Do something to change the angle of the stream.
'Draw a stream of river. change the angle 5 degree.'
Anxiety disorder
Exposure and relaxation
"Try not to stop the attack. agree to have it"
"put number to anxiety level, draw a chart of pattern"
explain about desensitization
every panic attack duration is consistent with each person
Meditation "tells you they are only thoughts. treat like a movie"
Zen temple at Packard street
One psychiatry in UofM
For Phobia, "what's the worst that can happen?"
Give a card, paper, or write down on memo
References
Depression
Feeling Good : The new mood therapy: David Burns
Panic
Don't Panic: Taking Control of Anxiety Attack : Reid Wilson
GAD
Stop Obsessing: How to ovecome your obsessions and compulsions: David Barlow, Edna Foa
Other authors: Craske, Steketee (OCD)
金曜午前は、予定が入らなかったので「認知行動療法」を学びたいと希望をしたところ
あいにくちょうど良いセッションがスケジュールされておらず
家庭医プログラム専属のpsychologistが
午前中いっぱいマンツーマンでレクチャーしてくれることに
なぜ「認知行動療法」を希望したかと言えば
日本でのこれまでの経験から
うつ病、パニック障害などの治療には、
長期的にみれば抗うつ剤単独よりも、認知行動療法単独もしくは抗うつ剤との併用の方が成績が良いことが分かっているにもかかわらず
「認知行動療法」をしている施設が限られ
紹介するにもできず、困っていました
自分でやってみようかと、独学で勉強するも
書籍例：いやな気分よ、さようならー自分で学ぶ「抑うつ」克服法
実際、10-15分の外来ではどうしたら良いかも分からず
結局SSRIを出しておしまいというのが日本での状況でした
そんな状況から「10-15分でできるミニ認知行動療法は無いのか？」というのが私の問い
そこで認知行動療法の概要から始まり
認知療法、行動療法を
うつ病、パニック障害、OCD、GADに対して
どのようにapplyするかという実践的な話をしました
以下は自分のためのまとめ
リラクゼーションのために作ったMP3の録音もいただきました
----------------------------------------------------------
CBT vs 精神分析
CBTはwhyではなくHowにfocus
Cognitive
dysfunctional thought
Events(trigger) ---> reaction
Behavior
1. Event(A) ----> reaction -----> Event (B) +reinforcement
then Event(A) ----> reaction (w/o Event B)
2. Event (A)
Event (B) --------> reaction
then Event (B) --------> reaction
Depression
Beck Depression Inventory is useful
" I am always ........." <-----
"If I whisper in your ear as such all day long, how will you feel?"
"Is that really true?"
1. Observe yourself carefully, think of yourself like a spy. Write just down in sentence, what you think, feel.
2. How strong do you believe? 0-100% scale?
3. Break through the pattern
Put the thought in trial
True-- Why true? List 3-5 examples
Exeptions -- What exception
Usually, pt may not list any exception. then ask "Anybody else w .......?(put other people)"
"Other reason that .....?"
"Have you had same situation before......, how did you feel?"
Key: Challenge the thought, do not say "destroy, cancel the thought"
Always put both sides
4. Then ask again
"How strong do you believe? 0-100% scale?"
5. Let them do dozens of times.
Behavior therapy
Like PT, expand psychological ROM, gradually
Only ask easy things they can do by sure, at least, over 80%
1. Ask to do easy, fun things. "just go out 5min/week"
Usually, they are not joyful for a while, so say
"Put seeds before, get express" "fake it until you make it"
"prime the pomp" "do this because it is good for you, I can reassure"
2. "what does depression tells you to do? write down. "
Do something to change the angle of the stream.
'Draw a stream of river. change the angle 5 degree.'
Anxiety disorder
Exposure and relaxation
"Try not to stop the attack. agree to have it"
"put number to anxiety level, draw a chart of pattern"
explain about desensitization
every panic attack duration is consistent with each person
Meditation "tells you they are only thoughts. treat like a movie"
Zen temple at Packard street
One psychiatry in UofM
For Phobia, "what's the worst that can happen?"
Give a card, paper, or write down on memo
References
Depression
Feeling Good : The new mood therapy: David Burns
Panic
Don't Panic: Taking Control of Anxiety Attack : Reid Wilson
GAD
Stop Obsessing: How to ovecome your obsessions and compulsions: David Barlow, Edna Foa
Other authors: Craske, Steketee (OCD)