統合失調症の思路障害に着目した認知行動療法—思路収斂法の試み

Cognitive Behavioral Therapy Focused on the Thought Processes of Schizophrenic Patients: A motivational attempt at convergent thinking

抄録　統合失調症の治療は薬物療法に限らず認知行動療法的アプローチなどを包括的に実施することが重要である。統合失調症に対する認知行動療法は思考内容の異常に対する研究や報告が多い。思路が解体し，滅裂思考を呈し病識も乏しい統合失調症患者では薬物療法の効果も乏しく，思考内容の異常の修正や変容を目標にして思考障害の改善を図ることはきわめて困難である。本論は，滅裂思考のために双方向性のコミュニケーションを図ることのできない統合失調症の患者に対して思考内容ではなく思考形式の障害に認知行動療法的に働きかけ，滅裂散乱した思路を収斂させること(「思路収斂法」)により思路を再構築し思考障害の改善を得た1例を報告するものである。

　In treating schizophrenia, it is imperative to comprehensively use cognitive behavioral therapeutic approaches, among others, and not be limited to pharmacotherapy treatments alone. Notably, in the realm of cognitive behavioral therapy for the treatment of schizophrenia, many studies have reported the presence of abnormal thought content. Moreover, schizophrenic patients suffering from thought flow cessation, disturbing thoughts, and poor awareness of the illness they carry, poorly benefit from the effects of pharmacotherapy, and improvements in thought processes, in order to correct or change abnormal thought content, are rather difficult. Here, we report a case of a schizophrenic patient with whom bidirectional communication was not possible because of thought disturbances. In this case, cognitive behavioral therapeutic approaches were used to change thinking patterns, independent of thought content, to achieve a convergence of incoherent thought flow(“motivational convergent thinking”) and a subsequent reconstruction of this flow, resulting in an improvement of the abnormal thought disturbances characteristic of schizophrenia.