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ãæ©ã¿ãã®å€ãã¯ãäœããã®ã¹ãã¬ããµãŒãããªãã¡å¿èº«ã«è² æ ããããåºæ¥äºãç¶æ³ãžã®åå¿ãšããŠçãããå¿çåŠçã«ç¹ã«æ³šç®ãããã®ã¯å¿çã»ç€ŸäŒçã¹ãã¬ããµãŒã§ãããããã«ã¯ä»äºäžã®åé¡ïŒäŸïŒééåŽåã責任ã倱æã人éé¢ä¿ãã¯ã¬ãŒã 察å¿ïŒãå®¶åºå ã®åé¡ïŒäŸïŒå®¶æéã®äžåãé¢å¥ã»æ»å¥ãä»è·ç²ãïŒãçµæžã»ç掻äžã®åé¡ïŒäŸïŒç掻èŠãå€éåµåïŒãå¥åº·äžã®åé¡ãªã©ãå«ãŸãã ããããã¯ãåŸè¿°ããèªç¥ã¢ãã«ã«ããããAïŒåºæ¥äºïŒãã«çžåœããããšãå€ã ã Â
ç©ççã¹ãã¬ããµãŒïŒæãå¯ããéšé³ïŒãååŠçã¹ãã¬ããµãŒïŒå ¬å®³ç©è³ªãè¬ç©ïŒãªã©ãã¹ãã¬ã¹åå¿ãåŒãèµ·ããã ãäžè¬çã«ãæ©ã¿ããšããŠæèãããã®ã¯ãå¿çã»ç€ŸäŒçã¹ãã¬ããµãŒãžã®åå¿ã§ããå Žåãå€ãã Â
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ã¹ãã¬ããµãŒããæ©ã¿ãã«ã€ãªãããã©ãããæ±ºå®ã¥ããäžã§ã極ããŠéèŠãªåœ¹å²ãæããã®ãèªç¥ãããªãã¡åºæ¥äºã®åãæ¢ãæ¹ãèãæ¹ã§ããã
èªç¥çè©äŸ¡ (Cognitive Appraisal): ã©ã¶ã«ã¹ãšãã©ã«ã¯ãã³ã®çè«ã«ããã°ãã¹ãã¬ã¹åå¿ã¯åºæ¥äºãã®ãã®ã§ã¯ãªãããã®åºæ¥äºãå人ãã©ã®ããã«è©äŸ¡ãããã«ãã£ãŠæ±ºãŸã ãäžæ¬¡è©äŸ¡ã§ã¯ãåºæ¥äºãèªåã«ãšã£ãŠè åšãã害ãããããææŠããªã©ã倿ãããäºæ¬¡è©äŸ¡ã§ã¯ããã®ç¶æ³ã«å¯ŸããŠèªåã¯ã©ã®ãããªå¯ŸåŠè³æºïŒèœåã瀟äŒçæ¯æŽãªã©ïŒãæã£ãŠãããããŸã察åŠã§ãããåŠãã倿ãã ããã®è©äŸ¡ããã»ã¹ãããæ©ã¿ãã®çºçãšåŒ·åºŠãå·Šå³ããã Â
ABCã¢ãã«: èªç¥çæ³ã®åºæ¬çãªèãæ¹ã瀺ãã¢ãã«ã§ãã ãAïŒActivating Event: åºæ¥äºïŒãçŽæ¥CïŒConsequence: çµæãšããŠã®ææ ãè¡åïŒãåŒãèµ·ããã®ã§ã¯ãªãããã®éã«BïŒBelief: 信念ãèãæ¹ãèªç¥ïŒãä»åšããBãCãæ±ºå®ãããšèãã ãã€ãŸãããæ©ã¿ãïŒCã®äžéšïŒã¯ãåºæ¥äºïŒAïŒã«å¯Ÿããå人ã®è§£éïŒBïŒããçããã®ã§ãããäžé©å¿çãªèªç¥ïŒBïŒããæ©ã¿ããæç¶ããã ã Â
èªåæè (Automatic Thoughts): ç¹å®ã®ç¶æ³ã§ç¬éçã«é ã«æµ®ãã¶æèãã€ã¡ãŒãžã®ããš ãå€ãã®å Žåãæèãããã«æµããŠãããããæ©ã¿ããæ±ããŠããæã«ã¯ããç§ã¯ãã¡ã ãããã£ãšå€±æãããã誰ãç§ã奜ãã§ã¯ãªãããšãã£ãåŠå®çãªèªåæèãé »ç¹ã«çŸããããšããã ããããã¯ãããæ·±ãã¬ãã«ã®ä¿¡å¿µãåæ ããŠããããšãå€ãã Â
èªç¥ã®æªã¿ã»ãã€ã¢ã¹ (Cognitive Distortions/Biases): ãã¬ãã£ããªææ ããæ©ã¿ããç¶æã»åŒ·åãããäœç³»çãªæèã®åã ãäŸãšããŠãæ ¹æ ãªãçµè«ãåºãæ£æçæšè«ãè¯ãç¹ãç¡èŠããŠæªãç¹ã ãæ³šç®ããéžæçæ³šç®ïŒéžæçæœè±¡åïŒãäžã€ã®å€±æãå šãŠã«åœãŠã¯ããé床ã®äžè¬åã倱æãé倧è©äŸ¡ãæåãéå°è©äŸ¡ããæ¡å€§è§£éã»éå°è©äŸ¡ãèªåã«é¢ä¿ãªããã¬ãã£ããªåºæ¥äºãèªåã®ããã«ããå人åïŒèªå·±é¢é£ã¥ãïŒãªã©ããã ããŸãããã¬ãã£ããªæ å ±ã«æ³šæãåããããèšæ¶ã«æ®ãããããã¬ãã£ããã£ã»ãã€ã¢ã¹ ãèªåã®èããæ¯æããæ å ±ã°ããæ¢ã確蚌ãã€ã¢ã¹ãä»è ã®æå³ãæµå¯Ÿçã«è§£éããããæµæåž°å±ãã€ã¢ã¹ ãæ§å¥ã«ããåºå®èŠ³å¿µã«åºã¥ããžã§ã³ããŒã»ãã€ã¢ã¹ ãªã©ãæ§ã ãªèªç¥ãã€ã¢ã¹ãå€æãæææ±ºå®ã«åœ±é¿ãäžãããæ©ã¿ãã®å 容ã匷床ã«é¢äžãã ããããã®ãã€ã¢ã¹ã¯ãéå»ã®çµéšãçŽæããç¡æèçã«çããããšããã ã Â
äžæ žç信念ã»ã¹ããŒã (Core Beliefs/Schemas): èªåæèã®æ ¹åºã«ãããèªå·±ãä»è ãäžçã«é¢ããããæ·±ããå®å®çã§ãå æ¬çãªä¿¡å¿µäœç³» ãäŸãã°ããç§ã¯ç¡äŸ¡å€ã ãã人ã¯ä¿¡çšã§ããªãããäžçã¯å±éºãªå Žæã ããšãã£ã信念ãããã«ããããããã¯ã®çè«ã§ã¯ãæãã€ã«ãªãããã人ã¯ãåŠå®çãªåºæ¥äºã«ãã£ãп޻æ§åããããããæãã€ã¹ããŒãããæã£ãŠãããšèããããŠãã ããããã®ã¹ããŒãããåºæ¥äºã®è©äŸ¡ïŒã¢ãã¬ã€ã¶ã«ïŒãèªåæèã«åœ±é¿ãäžããã Â
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ã¹ãã¬ã¹åå¿ç³»ã®åœ±é¿: æç¶çãªã¹ãã¬ã¹ã¯ãèŠåºäžéš-äžåäœ-å¯è ç®è³ªïŒHPAïŒç³»ãèªåŸç¥çµç³»ïŒç¹ã«äº€æç¥çµç³»ïŒãéå°ã«æŽ»æ§åãããããããé·æåãããšã身äœã®æåžžæ§ãä¹±ããæ§ã ãªåé¡ãåŒãèµ·ããã
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è¡åã®å€å: ã¹ãã¬ã¹åå¿ãšããŠã瀟äŒçãªåŒãããããåé¿è¡åã課é¡ã®å å»¶ã°ããä»äºäžã®ãã¹ã®å¢å ãé£è¡åãç¡ç ãã¿ãŒã³ã®å€åïŒéé£/飿¬²äžæ¯ãéç /äžç ïŒãã¢ã«ã³ãŒã«ãã¿ãã³ãªã©ã®ç©è³ªäœ¿çšéã®å¢å ãã€ã©ã€ã©ãæ»ææ§ã®äº¢é²ãšãã£ãè¡åã®å€åãèŠãããããšããã ã Â
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5.1. ã¹ãã¬ã¹ã³ãŒãã³ã°ã®ã¡ã«ããºã ïŒã©ã¶ã«ã¹&ãã©ã«ã¯ãã³ïŒ
ã¹ãã¬ã¹ã³ãŒãã³ã°çè«ã¯ããæ©ã¿ããžã®å¯ŸåŠè¡åãçè§£ããããã®åºæ¬çãªæ çµã¿ãæäŸãããã³ãŒãã³ã°ãšã¯ãã¹ãã¬ã¹ãã«ãªç¶æ³ïŒã¹ãã¬ããµãŒïŒã«ãã£ãŠçããè² æ ïŒã¹ãã¬ã¹åå¿ïŒã管çããããšãããæèçãªèªç¥çã»è¡åçåªåã§ãã ãäž»ãªçš®é¡ãšããŠä»¥äžãæããããã Â
åé¡çŠç¹åã³ãŒãã³ã° (Problem-Focused Coping): ã¹ãã¬ã¹ã®åå ãšãªã£ãŠããåé¡ç¶æ³ãã®ãã®ãå€åãããããšããå¯ŸåŠæ³ ãå ·äœçã«ã¯ãåé¡ã®åå ãåæããã解決çãèšç»ãå®è¡ãããé¢é£æ å ±ãéãããå¿ èŠãªã¹ãã«ãç¿åŸãããä»è ã«å ·äœçãªå©èšãæŽå©ïŒéå ·çãµããŒãïŒãæ±ããããªã©ãå«ãŸãã ãç¶æ³ãã³ã³ãããŒã«å¯èœã§ããå Žåã«ç¹ã«æå¹ãšãããã Â
æ åçŠç¹åã³ãŒãã³ã° (Emotion-Focused Coping): ã¹ãã¬ããµãŒã«ãã£ãŠåŒãèµ·ããããäžå¿«ãªææ ïŒã¹ãã¬ã¹åå¿ïŒã調æŽããããšããå¯ŸåŠæ³ ãå ·äœçã«ã¯ãæ°æŽãããããïŒè¶£å³ãéåã鳿¥œéè³ãªã©ïŒããªã©ã¯ãŒãŒã·ã§ã³ææ³ãçšãããææ ãä»è ã«è©±ããŠèããŠãããïŒææ çãµããŒãã®åžæ±ïŒãåºæ¥äºã®æãæ¹ãå€ããïŒèªç¥çåè©äŸ¡ïŒãåé¡ããè·é¢ã眮ãïŒåé¿ïŒãææ ãæããããªã©å€æ§ãªæ¹æ³ãå«ãŸãã ãç¶æ³ãã³ã³ãããŒã«å°é£ãªå Žåããåé¡çŠç¹åã³ãŒãã³ã°ãšäœµçšããŠçšããããããšãå€ãã Â
æå³çŠç¹åã³ãŒãã³ã° (Meaning-Focused Coping): ã¹ãã¬ã¹ãã«ãªåºæ¥äºã«è¯å®çãªæå³ãèŠåºãããã䟡å€èгã信念ã«åºã¥ããŠç¶æ³ãæãçŽãããããå¯ŸåŠæ³ãããã¯åŸè¿°ããèªç¥çåè©äŸ¡ããã¹ããã©ãŠããã£ãã¯ã»ã°ããŒã¹ïŒã»ã¯ã·ã§ã³7ïŒãšãé¢é£ããã
éèŠãªã®ã¯ãç¹å®ã®ã³ãŒãã³ã°ãåžžã«æå¹ãšã¯éãããç¶æ³ã®æ§è³ªïŒã³ã³ãããŒã«å¯èœãåŠããªã©ïŒãå人ã®ç¹æ§ã«å¿ããŠãæè»ã«æ§ã ãªã³ãŒãã³ã°æŠç¥ã䜿ãåããããšããã¹ãã¬ã¹ãžã®é©å¿ã«ã¯å¹æçã§ãããšããç¹ã§ãã ããŸããã©ã¶ã«ã¹ã®ã¢ãã«ã§ã¯ãã³ãŒãã³ã°ã¯èªåçãªåå¿ãç¡æèçãªé²è¡æ©å¶ãšã¯åºå¥ãããæèçãªåªåã䌎ããã®ãšããã ã Â
5.2. èªç¥åæ§ææ³ïŒCBTïŒ
èªç¥è¡åçæ³ïŒCognitive Behavior Therapy: CBTïŒã®äžæ žçãªææ³ã®äžã€ã§ããããæ©ã¿ãã®åå ãšãªãäžé©å¿çãªæèã信念ïŒABCã¢ãã«ã®BïŒãç¹å®ãããããããçŸå®çã§ãã©ã³ã¹ã®åãããã®ãžãšä¿®æ£ããããšãç®æã ã Â
ã³ã©ã æ³ (Column Method): èªç¥åæ§æãå®è·µããããã®å ·äœçãªããŒã«ãšããŠããæèèšé²è¡šïŒã³ã©ã 衚ïŒããç¹ã«7ã€ã®ã³ã©ã ãçšããæ¹æ³ãåºãç¥ãããŠãã ãããã¯ãèªå·±ã®èªç¥ã®æªã¿ã«æ°ã¥ããæèãæè»ã«ããããã®æ§é åãããã¯ãŒã¯ã·ãŒãã§ãã ã
CBTãç¹ã«èªç¥åæ§ææ³ã¯ããã€ç ãäžå®é害ãã¹ãã¬ã¹é¢é£é害ãªã©ãå€ãã®ç²Ÿç¥çåé¡ã«å¯ŸããŠç§åŠçæ ¹æ ã®ããæå¹ãªæ²»çæ³ãšããŠç¢ºç«ãããŠãã ã Â
5.3. è¡å掻æ§åãšåé¡è§£æ±ºææ³
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è¡å掻æ§å (Behavioral Activation): æãã€ããæ©ã¿ãã«äŒŽãåŒãããããæŽ»åææ¬²ã®äœäžã«å¯Ÿããæå³çã«ãæ¬äººã䟡å€ãæããæŽ»åãæ¥œããæŽ»åãžã®åå ãå¢ãããŠããããšã§ãæ°åãæ¹åããããžãã£ããªçµéšãå¢ããããšãç®æãã¢ãããŒã ã Â
åé¡è§£æ±ºææ³ (Problem-Solving Therapy: PST): ãæ©ã¿ãã®å®çŸ©ã«ãããã解決å°é£æ§ã ã«çŽæ¥å¯ŸåŠããããã®æ§é åãããææ³ ã以äžã®ã¹ãããã§å ·äœçãªåé¡è§£æ±ºãå³ã ã
åé¡ã®æç¢ºåãšç®æšèšå®: 解決ãããåé¡ãå ·äœçã«å®çŸ©ããéæãããç®æšãèšå®ããã
解決çã®ãã¬ã€ã³ã¹ããŒãã³ã°: è©äŸ¡ãæ¹å€ããããå¯èœãªè§£æ±ºçãã§ããã ãå€ãæããã
解決çã®è©äŸ¡: å解決çã®ã¡ãªããã»ãã¡ãªãããæ€èšããã
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çµæã®è©äŸ¡: å®è¡çµæãè©äŸ¡ãã广ãããã°å®äºããªããã°ã¹ããã2ã4ã«æ»ãä¿®æ£ããã PSTã¯ããã€ç ãäžå®çã®æ²»çãè·å Žé©å¿ã®ä¿é²ãªã©ãæ§ã ãªå Žé¢ã§æŽ»çšãããå ·äœçãªå¯ŸåŠèœåã®åäžã«åœ¹ç«ã€ ã Â
5.4. ãã€ã³ããã«ãã¹ãã¢ã¯ã»ãã¿ã³ã¹ãã»ã«ãã»ã³ã³ããã·ã§ã³
è¿å¹Žæ³šç®ãããŠããã¢ãããŒããšããŠãæèãææ ãšãéããã®ã§ã¯ãªããããããšã®ãé¢ããæ¹ããå€ããããšã«çŠç¹ãåœãŠããã®ãããã
ãã€ã³ããã«ãã¹ (Mindfulness): ãä»ããã®ç¬éã®çµéšã«ãè©äŸ¡ã倿ãå ããããšãªããæå³çã«æ³šæãåããããšããåè»æèãå¿é ã®ãµã€ã¯ã«ããæãåºããæèãææ ã客芳çã«èгå¯ããã¹ãã«ãé€ã ãåŒåžçæ³ãããã£ã¹ãã£ã³ãšãã£ãå®è·µããã ãã¹ãã¬ã¹ãäžå®ãæãã€ã®è»œæžãQOLã®åäžãªã©ã«å¹æãããããšãå€ãã®ç ç©¶ïŒã¡ã¿åæãå«ãïŒã§ç€ºãããŠãã ã Â
ã¢ã¯ã»ãã¿ã³ã¹ (Acceptance): äžå¿«ãªæèãææ ãèº«äœæèŠãªã©ããå€ããããšæµæããã®ã§ã¯ãªããããããŸãŸã«åãå ¥ããæ åºŠãããã«ããããããã«æ¯ãåããã床åããæžããããšãç®æãïŒã¢ã¯ã»ãã¿ã³ã¹ïŒã³ãããã¡ã³ãã»ã»ã©ããŒïŒACTïŒã®äžå¿æŠå¿µïŒã Â
ã»ã«ãã»ã³ã³ããã·ã§ã³ (Self-Compassion): å°é£ã倱æã«çŽé¢ããéã«ãèªåèªèº«ã«å¯ŸããŠæ¹å€çã«ãªãã®ã§ã¯ãªããåªãããçè§£ããã£ãŠæ¥ããããš ãâ èªåãžã®åªãããâ¡å ±éã®äººéæ§ïŒèª°ããäžå®å šã§èŠããååšã§ããããšã®èªèïŒãâ¢ãã€ã³ããã«ãã¹ïŒèŠçãªææ ã«æ°ã¥ãã€ã€ããããã«é£²ã¿èŸŒãŸããªãïŒã®3èŠçŽ ããæãã粟ç¥çå¥åº·ã®åäžãã¹ãã¬ã¹ãäžå®ã®è»œæžãã¬ãžãªãšã³ã¹ã®åŒ·åãªã©ã«å¯äžããããšãç ç©¶ã§ç€ºåãããŠãã ã Â
5.5. ãªã©ã¯ã»ãŒã·ã§ã³ææ³
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挞é²ççåŒç·©æ³ (Progressive Muscle Relaxation: PMR): ãžã§ã€ã³ããœã³ã«ãã£ãŠéçºããããäœã®åéšäœã®çèãæå³çã«ç·åŒµãããåŸãåŒç·©ãããããšãç¹°ãè¿ãããšã§ãæ·±ããªã©ã¯ã»ãŒã·ã§ã³ç¶æ ãå°ãæ¹æ³ ãæãè ãèäžãè©ãéŠãé¡ãè ¹éšãè¶³ãªã©ãå šèº«ã®çèãé çªã«è¡ã ã宿œåŸã«ã¯ãèŠéãä¿ãããã®æ¶å»åäœãå¿ èŠãªå Žåããã ã Â
åŒåžæ³ (Breathing Exercises): æèçã«åŒåžãã³ã³ãããŒã«ããããšã§ãèªåŸç¥çµç³»ã®ãã©ã³ã¹ãæŽããå¿èº«ããªã©ãã¯ã¹ãããæ¹æ³ãç¹ã«ããã£ãããšããè ¹åŒåŒåžãæå¹ãšããã ãä»ã®ãªã©ã¯ã»ãŒã·ã§ã³æ³ãšçµã¿åãããŠçšããããããšãå€ã ã Â
ãã®ä»ã®æ¹æ³: èªå°ã€ã¡ãŒãžæ³ ãçæ³ ããšã¬ ãå ¥æµŽããããµãŒãžã鳿¥œéè³ãè¶£å³ãžã®æ²¡é ãèªç¶ã«è§Šããããš ãªã©ãå人ã«åã£ã倿§ãªãªã©ãã¯ã¹æ³ãååšãã ã Â
5.6. ãœãŒã·ã£ã«ãµããŒãã®æŽ»çš
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