短期的で具体的な課題設定により行動変容が促進された強い不安を抱えた自閉スペクトラム症を有する一事例

Facilitating behavior modification in adults with severe anxiety and autism spectrum disorder through short-term specific goal setting: A case report

要旨：本論文は，自閉スペクトラム症とうつ病が併発した40代男性の事例の経過を報告した．治療初期には，長期的で抽象度の高い目標を基に課題を設定したが，十分な行動変容には至らなかった．そこで，評価の修正を行い，クライアント（以下，Cl.）の興味に基づいて短期的で具体的な課題を再設定した結果，行動変容が生じ，不安も軽減した．生活の自立度が上がり，家族関係や対人行動にも改善が認められたことから，治療後期には面接とデイケアを利用し，福祉的就労に至った．以上の経過から，強い不安とともに自閉スペクトラム症がある事例への対応においては，Cl．の興味に基づいて短期的で具体的な課題を設定することが重要であると示唆された．

　This report describes the treatment process for an adult with autistic spectrum disorder, comorbid depression, and anxiety. The client received 34 sessions that included psychoeducation, behavioral activation, and behavioral experiment. A psychiatric daycare service was used at the end of the treatment. In the early stages of treatment, the therapist set long-term and abstract treatment goals, resulting in insufficient behavioral change. Given this result, the therapist conducted case formulation again and reset short-term and concrete tasks related to the client's interests. This treatment effort was accompanied by modified behavior and reduced anxiety in the client. As the client's level of independence in daily life increased and improvements in family relationships and interpersonal behavior were observed, daycare was also used. Finally, the client was employed in social services. These results suggest that it is important to set short-term, specific tasks based on the client's interests when dealing with a case with autism and comorbid depression and anxiety.