認知行動療法を用いた作業療法実践により自己効力感が向上し階段昇降が獲得できた事例

Improvement of self-efficacy and stair climbing through occupational therapy using cognitive behavioral therapy: A case study

要旨：本事例は，人工膝関節置換術後に不安と抑うつを認め，自己効力感が低下していた．カナダ作業遂行測定（以下，COPM）によって挙げられた階段昇降が，術前の転落経験による不安感から困難となっていたため認知行動療法を実践した．事例は，認知行動療法を通して，自動思考の歪みへの気づきにつながり，段差昇降を段階的に実施していくことが可能となり，達成感から自己効力感が向上し，階段昇降を獲得した．それに伴い，COPMにおいても階段が遂行度1から6，満足度1から6と向上した．本事例を通して，不安感が強く自動思考の歪みによって作業療法実践が困難な事例に対して認知行動療法を用いることは，目標達成の促進につながる可能性が示された．

　The case experienced total knee arthroplasty (TKA) which resulted in anxiety, depression and decreased self-efficacy. The Canadian Occupational Performance Measure (COPM) indicated difficulty moving up and down stairs, resulting in cognitive behavioral therapy to alleviate the anxiety caused by the preoperative fall experience. As a result, the case became experienced cognitive distortion, and began to carry out climbing in stages, leading to a sense of accomplishment, and improved self-efficacy and stair climbing. Furthermore, COPM indices improved from 1 to 6 in both the categories of performance and satisfaction. This indicates that cognitive behavioral therapy in cases where occupational therapy is difficult due to anxiety and distortion can promote goal achievement.