統合失調症の慢性期にある50代女性患者のアクセプタンス＆コミットメント・セラピー（ACT）参加による価値に結びついた主観的体験の変化のプロセス

Process of Change in Subjective Experiences tied to Values by Participation in Acceptance and Commitment Therapy (ACT) in a Female Patient in Her 50s with Chronic Schizophrenia

要旨

　目的：統合失調症の慢性期にある50代女性患者のアクセプタンス＆コミットメント・セラピー（ACT）参加による価値に結びついた体験の変化のプロセスを明らかにすることでパーソナルリカバリー支援への示唆を得る．

　方法：A氏に半構造化面接を実施した．パーソナルリカバリーにつながる価値に結びついた体験について質的記述的に分析した．事例を捉える他の証拠源には価値に基づく行動の自己記録を用いた．

　結果：依存しない老後のため【家事をやらなければならない思いとやりたくない思いとの間で葛藤する】体験があった．ACT開始後【試行錯誤と不安への対処によって尊敬する母を目標に家事に取り組む】体験があり，家事行動が拡大し【家族と仲良く暮らしたい希望を持ち母を意識し家事する機会を増やす】体験を積み上げていた．

　結論：パーソナルリカバリーという変化のプロセスを共に歩み，主観的で個別的な体験に焦点をあてる支援の重要性が示唆された．

　Objective: To clarify the process of change in subjective experiences tied to values by a female patient in her 50s in the chronic phase of schizophrenia who participated in Acceptance and Commitment Therapy (ACT) and to obtain suggestions for personal recovery support.

　Methods: A semi-structured interview was conducted with the female, and her subjective experiences, in which she had tied to values, and her personal recovery had been promoted, were qualitatively and descriptively analyzed. As another source of evidence for this case study, her value-directed behavior records created by herself were used.

　Results: She experienced [a mental conflict due to hating to do housework while knowing that she has to do it] not to become dependent with aging. Her experiences after the initiation of ACT were represented by [repeating trials and errors and coping with anxiety to manage household chores with her respectful mother as a model] and [desiring to live well with other family members, modeling herself after her mother, and increasingly doing housework], which promoted her household behavior.

　Conclusion: The results suggest the importance of sharing personal recovery as a process of change and focusing on subjective and individual experiences when supporting people with schizophrenia.