强迫障碍的认知行为个案概念化咨询个案报告

摘要

探讨如何从认知理论和行为理论的视角建构强迫障碍的个案概念化,以及个案概念化对制定咨询策略的重要指导作用.以一例强迫障碍大学生为对象,依据强迫障碍的认知行为概念化模型对其强迫症状发生、发展及维持的机制进行解析,在此基础上制定暴露与反应阻止技术结合认知技术的干预策略,开展为期13周共计17次的咨询实践.采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和耶鲁-布朗强迫量表(Y-BOCS)对症状的严重程度进行基线和干预13周后评估.结果显示,来访者焦虑和抑郁的情绪均有明显下降,Y-BOCS得分从咨询前25分降低为咨询后11分,每天花费在强迫检查、强迫清洗上的时间明显减少,社会功能恢复正常.结果提示,强迫障碍的认知理论和行为理论能有效指导个案概念化的建构过程和咨询实践.%To explore how to formulate the case conceptualization of obsessive-compulsive disorder (OCD) in the perspective of cognitive theory and behavioral theory. The current study utilized the cognitive behavioral conceptualization model to account for the development and maintenance of obsessive-compulsive symptoms of a college student with OCD. An intervention strategy combining exposure and reaction prevention (ERP) with cognitive techniques was implemented within a 17-session individual counseling in 13 weeks. Client's anxious, depressive and obsessive-compulsive symptoms were assessed at baseline and after 13-week intervention with the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS), respectively. Results showed a significant decrease in anxiety and depressive symptoms. The score of Y-BOCS decreased from 25 to 11 after intervention, which indicated normal social functioning. These findings suggested that the cognitive theory and behavioral theory of OCD could effectively guide the process of case conceptualization and the counselling practice.