ãã®äžçå ±éã®ç°¡åãªãã³ãã§ãå®ãããªå€ãšæŽ»æ°ããæ¥ãæã«å ¥ããŸãããã
æ¯æ©ãã£ããç ãããã®ç°¡åãªãã³ã
çŸä»£ã®ããŒã¹ã®éãäžçã§ã¯ã質ã®é«ãç¡ç ã¯ãã°ãã°äºã®æ¬¡ã«ãããã¡ã§ããããããç¡ç ãåªå ããããšã¯ã身äœçã»ç²Ÿç¥çãªå¥åº·ã«ãšã£ãŠéåžžã«éèŠã§ããç¡ç ã¯ãæ°åãçç£æ§ããå ç«ã·ã¹ãã ãé·æçãªå¥åº·ã«è³ããŸã§ããããããã®ã«åœ±é¿ãäžããŸãããã®èšäºã§ã¯ãäžçäžã©ãã«ããŠããç¡ç ã®è³ªãæ¹åãããã£ãããšããæ°åã§ç®èŠããããã«ãæ¯æ¥ã®ã«ãŒãã³ã«åãå ¥ããããã·ã³ãã«ã§å®è·µçãªãã³ãã玹ä»ããŸãã
ç¡ç ã®éèŠæ§ãçè§£ãã
ç¡ç ã¯åã«äŒæ¯ããããšã ãã§ã¯ãããŸãããããã¯çç©åŠçãªåºæ¬çãªããŒãºã§ããç¡ç äžãäœã¯çµç¹ã修埩ããèšæ¶ãæŽçãããã«ã¢ã³ã調ç¯ããŸããæ ¢æ§çãªç¡ç äžè¶³ã¯ãå ç«åã®äœäžãç³å°¿ç ãå¿èç ãªã©ã®æ ¢æ§çŸæ£ã®ãªã¹ã¯å¢å ãèªç¥æ©èœã®äœäžãæ°åé害ãªã©ãããŸããŸãªå¥åº·åé¡ã«ã€ãªããå¯èœæ§ããããŸãã
çæ³çãªç¡ç æéã¯äººã«ãã£ãŠç°ãªããŸãããã»ãšãã©ã®æäººã¯æ¯æ©7ã9æéã®è³ªã®é«ãç¡ç ãå¿ èŠãšããŸããåäŸããã£ãŒã³ãšã€ãžã£ãŒã¯éåžžãããã«å€ãã®ç¡ç ãå¿ èŠãšããŸãã
ãªã©ãã¯ã¹ã§ããå°±å¯åã®ã«ãŒãã³ãäœã
äžè²«ããå°±å¯åã®ã«ãŒãã³ã確ç«ããããšã¯ãäœã«ãªã©ãã¯ã¹ããæéã§ããããšãç¥ãããåå³ãšãªããŸãããã®ã«ãŒãã³ã¯ãç©ããã§æ¥œãããã®ã§ããã¹ãã§ãæ¥äžã®ã¹ãã¬ã¹ãããªã©ãã¯ã¹ããç¶æ ãžã®ç§»è¡ãå©ããŸããæ€èšãã¹ãã¢ã€ãã¢ãããã€ã玹ä»ããŸãã
1. äžè²«ããç¡ç ã¹ã±ãžã¥ãŒã«
鱿«ãå«ããæ¯æ¥åããããã®æéã«å¯ãŠèµ·ããããã«ããŸããããããã¯ãæŠæ¥ãªãºã ãšããŠãç¥ãããäœã®èªç¶ãªç¡ç ã»èŠéãµã€ã¯ã«ã調ç¯ããã®ã«åœ¹ç«ã¡ãŸããç¡ç ã¹ã±ãžã¥ãŒã«ã®ããããªããã§ãããã®ãªãºã ãä¹±ããç ãã«ã€ãããããã£ãããšç®èŠãããããããšãé£ããããå¯èœæ§ããããŸããé »ç¹ã«æ è¡ããå Žåã¯ãæå·®ãã±ãæå°éã«æããããã«ãç¡ç ã¹ã±ãžã¥ãŒã«ãåŸã ã«èª¿æŽããŠã¿ãŠãã ããã
2. ããžã¿ã«ãããã¯ã¹
ã¹ããŒããã©ã³ãã¿ãã¬ãããã³ã³ãã¥ãŒã¿ãŒãªã©ã®é»åæ©åšããæŸåºããããã«ãŒã©ã€ãã¯ãç¡ç ã調ç¯ãããã«ã¢ã³ã§ããã¡ã©ããã³ã®çæã劚ããããšããããŸããå¯ãå°ãªããšã1æéåããã¯ããããã®ããã€ã¹ã®äœ¿çšãé¿ããŸãããã代ããã«ãèªæžãç©ãããªé³æ¥œãèŽããæž©ããã颚åã«å ¥ããªã©ããªã©ãã¯ã¹ã§ããæŽ»åãéžã³ãŸãããã
3. ãªã©ã¯ãŒãŒã·ã§ã³ãã¯ããã¯
å°±å¯åã®ã«ãŒãã³ã«ãªã©ã¯ãŒãŒã·ã§ã³ãã¯ããã¯ãåãå ¥ããŠãå¿ãšäœãèœã¡çãããŸãããããããã®ãã¯ããã¯ã«ã¯ä»¥äžã®ãããªãã®ããããŸãã
- æ·±åŒåžãšã¯ãµãµã€ãºïŒãã£ãããšããæ·±ãåŒåžã«éäžããŠãç¥çµç³»ãèœã¡çãããŸãããã
- çæ³ãŸãã¯ãã€ã³ããã«ãã¹ïŒã¬ã€ãä»ãçæ³ããã€ã³ããã«ãã¹ãšã¯ãµãµã€ãºãå®è·µããŠãå¿ãéããã¹ãã¬ã¹ã軜æžããŸããããç¡ç ã®ããã®ã¬ã€ãä»ãçæ³ãæäŸããã¢ããªããªã³ã©ã€ã³ãªãœãŒã¹ã¯æ°å€ããããŸãã
- 挞é²ççåŒç·©æ³ïŒäœã®ããŸããŸãªçè矀ãç·åŒµãããŠããåŒç·©ãããããšã§ãçèã®ç·åŒµãåããããªã©ã¯ãŒãŒã·ã§ã³ãä¿é²ããŸãã
- 軜ãã¹ãã¬ãããŸãã¯ãšã¬ïŒè»œãã¹ãã¬ããããªã¹ãã©ãã£ããšã¬ã®ããŒãºã¯ãç·åŒµãåãããäœãç¡ç ã®æºåã«æŽããã®ã«åœ¹ç«ã¡ãŸãã
4. æž©ããã颚åãŸãã¯ã·ã£ã¯ãŒ
å¯ãåã«æž©ããã颚åãã·ã£ã¯ãŒã济ã³ãããšã¯ãäœæž©ãäžããã®ã«åœ¹ç«ã¡ãè³ã«ç ãæéã§ããããšãç¥ãããŸãããšããœã ãœã«ããã©ãã³ããŒãªã©ã®ãšãã»ã³ã·ã£ã«ãªã€ã«ãå ãããšãããã«ãªã©ã¯ãŒãŒã·ã§ã³å¹æãé«ããããšãã§ããŸãã
5. èªæž
ïŒç»é¢ã§ã¯ãªãïŒçŽã®æ¬ãèªãããšã¯ãå¯ãåã«ãªã©ãã¯ã¹ããã®ã«åœ¹ç«ã€æ¹æ³ã§ããç¥çåºæ¿çãŸãã¯ææ çã«åæºããããããªãã®ã§ã¯ãªãã軜ããŠæ¥œãããèªã¿ç©ãéžã³ãŸãããã
ç¡ç ç°å¢ãæé©åãã
ããªãã®ç¡ç ç°å¢ã¯ãç¡ç ã®è³ªã«å€§ããªåœ¹å²ãæãããŸããå¿«é©ã§ãæããéãã§ãæ¶Œãã空éãäœãããšã¯ãå®ãããªç¡ç ãä¿é²ããŸãã
1. æã
å¯å®€ã¯ã§ããã ãæãããŸããããé®å ã«ãŒãã³ããã©ã€ã³ãã䜿çšããŠãå€éšã®å ã鮿ããŠãã ãããããããªå ã§ãã¡ã©ããã³ã®çæã劚ããããšããããŸããéšå±ã®å ãå®å šã«æé€ã§ããªãå Žåã¯ãã¢ã€ãã¹ã¯ã®äœ¿çšãæ€èšããŠãã ããã
2. éãã
å¯å®€ã®éšé³ãæå°éã«æããŸããããè³æ ããã¯ã€ããã€ãºãã·ã³ã䜿çšããŠãæ°ãæ£ããé³ã鮿ããŠãã ããããã¯ã€ããã€ãºã¯ãä»ã®é³ããã¹ãã³ã°ããããäžè²«æ§ã®ããç©ãããªé³ç°å¢ãäœæããã®ã«åœ¹ç«ã¡ãŸãã
3. æ¶Œããæž©åºŠ
å¯å®€ã®æž©åºŠã¯æ¶Œããä¿ã¡ãçæ³çã«ã¯è¯æ°60ã67åºŠïŒææ°15ã19床ïŒã«ããŸããããããäœã枩床ã¯äœæž©ã®äœäžã«åœ¹ç«ã¡ãããã¯ç ãã«ã€ãããã«äžå¯æ¬ ã§ãã
4. å¿«é©ãªãããã¬ã¹ãšæ
äœã«ååãªãµããŒããæäŸããå¿«é©ãªãããã¬ã¹ãšæã«æè³ããŸãããããµããŒãã®è¶³ããªããããã¬ã¹ãæã¯ãçã¿ãããã°ããåŒãèµ·ãããå¿«é©ã«ç ãããšãé£ããããŸãããããã¬ã¹ãšæãéžã¶éã«ã¯ãããªãã®å¯å§¿å¢ãèæ ®ããŠãã ãããæšªåãå¯ã®äººã¯ããã硬ãã®ãããã¬ã¹ãšåãã®æãé©ããŠããããšãå€ãã§ãããä»°åãå¯ã®äººã¯ãäžçšåºŠã®ç¡¬ãã®ãããã¬ã¹ãšèãã®æã奜ããããããŸããããã€äŒãå¯ã®äººã¯ãéåžžãããæããããããã¬ã¹ãšéåžžã«èãæãå¿ èŠã§ãã
5. æŽé ããã空é
æ£ããã£ãŠããŠæŽçãããŠããªãå¯å®€ã¯ãèŠèŠçã«åºæ¿çã§ã¹ãã¬ã¹ãæãããããªã©ãã¯ã¹ããŠç ãã«ã€ãã®ãé£ããããããšããããŸããããç©ããã§å®ãããªç°å¢ãäœãããã«ãå¯å®€ãæž æœã«æŽé ããŠãããŸãããã
ããè¯ãç¡ç ã®ããã®é£äºã®é æ ®
äœãé£ã¹ãã飲ãã ããããã¯ãç¡ç ã®è³ªã«å€§ããªåœ±é¿ãäžããå¯èœæ§ããããŸããç¹å®ã®é£åã飲æã¯ç¡ç ã劚ããããšããããŸãããä»ã®ãã®ã¯ãªã©ã¯ãŒãŒã·ã§ã³ãä¿é²ããŸãã
1. ã«ãã§ã€ã³ãšã¢ã«ã³ãŒã«ã®å¶é
ã«ãã§ã€ã³ãšã¢ã«ã³ãŒã«ã¯ã©ã¡ããç¡ç ã劚ããããšããããŸããã«ãã§ã€ã³ã¯èŠéäœçšããããç æ°ã劚ããç ãã«ã€ãèœåã«åœ±é¿ãäžããŸããã¢ã«ã³ãŒã«ã¯æåã¯ç æ°ãèªããŸãããå€é ãã«ã¯ç¡ç ã劚ããæç¶çãªç¡ç ãæ©æã®ç®èŠãã«ã€ãªããå¯èœæ§ããããŸããå¯ãæ°æéåããã¯ãã«ãã§ã€ã³ãšã¢ã«ã³ãŒã«ãé¿ããŸãããã
2. å¯ãåã®éãé£äºãé¿ãã
å¯ãçŽåã®å€§éã®é£äºã¯ç¡ç ã劚ããããšããããŸããäœã¯é£ã¹ç©ãæ¶åããããã«äžçæžåœåããªããã°ãªãããããããªã©ã¯ãŒãŒã·ã§ã³ã劚ããããšããããŸããå¯ãåã«ãè ¹ã空ããŠããå Žåã¯ããªãŒãããŒã«å°éãæç©äžåãããŸãã¯ãããäžæŽã¿ã®ãããªã軜ããŠå¥åº·çãªã¹ããã¯ãéžã³ãŸãããã
3. æ°Žåè£çµŠ
è±æ°Žçç¶ãç¡ç ã劚ããããšããããŸããæ¥äžååãªæ°Žåãæãããã«ããŸãããããã ããå¯ãçŽåã®éå°ãªæ°Žåæåã¯ãå€éã®é »ç¹ãªãã€ã¬ã®åå ãšãªãããé¿ããŸãããã
4. ç¡ç ãä¿é²ããé£åãæ€èšãã
ç¹å®ã®é£åã«ã¯ããªã©ã¯ãŒãŒã·ã§ã³ãšç¡ç ãä¿é²ããæ é€çŽ ãå«ãŸããŠããŸãããããã«ã¯ä»¥äžã®ãããªãã®ããããŸãã
- ã¿ã«ããã§ãªãŒïŒã¿ã«ããã§ãªãŒã¯ã¡ã©ããã³ã®å€©ç¶æºã§ãã
- ããŠã€ïŒããŠã€ã¯æé žåç©è³ªãšã»ãããã³ãè±å¯ã§ãç¡ç ãä¿é²ããŸãã
- ã¢ãŒã¢ã³ãïŒã¢ãŒã¢ã³ãã¯çèããªã©ãã¯ã¹ãããã®ã«åœ¹ç«ã€ãã°ãã·ãŠã ã®è¯ãäŸçµŠæºã§ãã
- æž©ãããã«ã¯ïŒæž©ãããã«ã¯ã«ã¯ããªãããã¡ã³ãå«ãŸããŠããŸããããã¯ã¡ã©ããã³ãšã»ãããã³ã®åé§äœã§ããã¢ããé žã§ãã
- ã«ã¢ããŒã«ãã£ãŒïŒã«ã¢ããŒã«ãã£ãŒã«ã¯ãªã©ã¯ãŒãŒã·ã§ã³ãä¿é²ããã®ã«åœ¹ç«ã€é®éäœçšããããŸãã
ã¹ãã¬ã¹ãšäžå®ã®ç®¡ç
ã¹ãã¬ã¹ãšäžå®ã¯ãç¡ç åé¡ã®äžè¬çãªåå ã§ããã¹ãã¬ã¹ãšäžå®ã管çããããšãåŠã¶ããšã¯ãç¡ç ã®è³ªãå€§å¹ ã«æ¹åããããšãã§ããŸãã
1. ã¹ãã¬ã¹èŠå ãç¹å®ãã察åŠãã
ããªãã®ç掻ã«ãããã¹ãã¬ã¹ãšäžå®ã®åå ãç¹å®ããããã«å¯ŸåŠããããã®ã¹ããããèžã¿ãŸããããããã«ã¯ãå¢çãèšå®ããããšãã¿ã¹ã¯ãå§ä»»ããããšããŸãã¯å°éå®¶ã®å©ããæ±ããããšãå«ãŸããå ŽåããããŸãã
2. ã¹ãã¬ã¹è»œæžãã¯ããã¯ã®å®è·µ
æ¥åžžã®ã«ãŒãã³ã«ã¹ãã¬ã¹è»œæžãã¯ããã¯ãåãå ¥ããŸãããããããã®ãã¯ããã¯ã«ã¯ä»¥äžã®ãããªãã®ããããŸãã
- éåïŒå®æçãªéåã¯ãã¹ãã¬ã¹ã軜æžããç¡ç ãæ¹åããã®ã«åœ¹ç«ã¡ãŸãããã ããå¯ãçŽåã®æ¿ããéåã¯é¿ããŸãããã
- èªç¶ã®äžã§éããïŒå±å€ã§éããããšã¯ãã¹ãã¬ã¹ã軜æžããæ°åãæ¹åããããšã瀺ãããŠããŸãã
- 瀟äŒäº€æµïŒå人ãå®¶æãšäº€æµããããšã¯ãã¹ãã¬ã¹ã軜æžãã粟ç¥çãªãµããŒããæäŸããã®ã«åœ¹ç«ã¡ãŸãã
- è¶£å³ïŒæ¥œããè¶£å³ã«åŸäºããããšã¯ãã¹ãã¬ã¹ã®å€ãèãããæ°ããããããªã©ã¯ãŒãŒã·ã§ã³ãä¿é²ããã®ã«åœ¹ç«ã¡ãŸãã
3. ãžã£ãŒããªã³ã°
ãžã£ãŒãã«ã«èªåã®èããææ ãæžãåºãããšã¯ãææ ãåŠçããã¹ãã¬ã¹ã軜æžããã®ã«åœ¹ç«ã¡ãŸããå¯ãåã«ãžã£ãŒããªã³ã°ã詊ããŠãå¿ãã¯ãªã¢ã«ããç¡ç ã®æºåãããŸãããã
4. äžç çã«å¯Ÿããèªç¥è¡åçæ³ïŒCBT-IïŒ
CBT-Iã¯ãäžç çãåŒãèµ·ããæèãè¡åãå€ããããšã«çŠç¹ãåœãŠãæ²»çæ³ã§ããããã¯äžç çã«å¯Ÿããéåžžã«å¹æçãªæ²»çæ³ã§ããã察é¢ãŸãã¯ãªã³ã©ã€ã³ã§è¡ãããšãã§ããŸããç±³åœãã«ãããè±åœããªãŒã¹ãã©ãªã¢ãªã©å€ãã®åœã§ã¯ãè³æ Œã®ããCBT-Iã»ã©ãã¹ããžã®ã¢ã¯ã»ã¹ãå¢å ããŠããŸãããå°ççãªå©çšå¯èœæ§ã¯ç°ãªããŸããå€ãã®ã»ã©ãã¹ããå®å šãªãããªäŒè°ãæäŸããŠããããã®æ²»çæ³ãããå©çšããããããŠããŸãã
å°éå®¶ã®å©ããæ±ããã¹ãæ
ãããã®ãã³ãã詊ããŠããŸã ç¡ç ã«åé¡ãããå Žåã¯ãå°éå®¶ã®å©ããæ±ããããšãéèŠã§ããå»åž«ãŸãã¯ç¡ç å°éå®¶ã¯ãããªãã®ç¡ç ãè©äŸ¡ããç¡ç åé¡ã®åå ãšãªã£ãŠããå¯èœæ§ã®ããæ ¹æ¬çãªå»åŠçç¶æ ãç¹å®ããããšãã§ããŸãã圌ãã¯ãç¡ç æ€æ»ãªã©ã®è¿œå æ€æ»ãæšå¥šããããç¡ç ãå©ããè¬ãåŠæ¹ãããããå ŽåããããŸãã
å°éå®¶ã®å©ããæ±ããã¹ãå åã«ã¯ä»¥äžã®ãããªãã®ããããŸãã
- ç ãã«ã€ãã®ãé£ããããŸãã¯3ã¶æä»¥äžç ãç¶ããããšãã§ããªãã
- ååãªç¡ç ããšã£ãŠããã«ãããããããæ¥äžã«ç²ããŠãããšæããã
- ãã³ãã倧ããããŸãã¯ç¡ç äžã«æ¯ãè©°ãŸãããã
- æ¥äžã®ç æ°ãæ¥åžžçæŽ»ã«æ¯éãããããŠããã
- éäžåãèšæ¶åã®äœäžãããã
- æ°åã®å€åãã€ã©ã€ã©ãçµéšããã
çµè«
ç¡ç ã®è³ªãæ¹åããããšã¯ãå šäœçãªå¥åº·ãšå¹žçŠãžã®æè³ã§ãããããã®ç°¡åãªãã³ããæ¥åžžã®ã«ãŒãã³ã«åãå ¥ããããšã§ãå®ãããªç¡ç ãä¿é²ããç¡ç ç°å¢ãäœãåºãããã£ãããšããå æ°ãªæ°åã§ç®èŠããããšãã§ããŸããå¿è匷ãäžè²«æ§ãæã€ããšã倧åã§ãããªããªããå€§å¹ ãªæ¹åãèŠãã«ã¯æéããããå Žåãããããã§ãããããŠãæ ¢æ§çãªç¡ç åé¡ã«èŠããã§ããå Žåã¯ãé æ ®ãªãå°éå®¶ã®å©ããæ±ããŠãã ããã
å 責äºé ïŒãã®æ å ±ã¯äžè¬çãªç¥èããã³æ å ±æäŸã®ã¿ãç®çãšãããã®ã§ãããå»çã¢ããã€ã¹ãæ§æãããã®ã§ã¯ãããŸãããå¥åº·äžã®æžå¿µãããå ŽåããŸãã¯å¥åº·ãæ²»çã«é¢ããæ±ºå®ãäžãåã«ã¯ãå¿ ãè³æ Œã®ããå»çå°éå®¶ã«ãçžè«ãã ããããã®æ å ±ã«äŸæ ããããšã¯ããã¹ãŠèªå·±è²¬ä»»ãšãªããŸãã