Post L, Collins C
Int J Psychiatry Med. 1981;11(2):173-82. doi: 10.2190/vuvv-2rqv-ag30-dpl1.
An etiology of maladaptive coping in Chronic Obstructive Pulmonary Disease is proposed and a model for psychotherapeutic intervention with poorly coping COPD patients is presented. Failure in mourning, manifested by a lack of shift in patient's expectations and goals leads to: 1) difficulty in accepting illness related feelings of loss; 2) chronic anxiety; 3) attribution of responsibility for feelings and behavior to external factors; and 4) poor compliance with medical regime. Recommendations for establishing a therapeutic alliance with the poorly coping patient are discussed. Psychotherapeutic intervention aims at: 1) facilitating acceptance of losses and restructuring of life goals; 2) interrupting the cycle of alienation and social withdrawal; and 3) increasing patient's control over affective arousal and respiratory functioning. Utilization of supportive individual psychotherapy, family or marital therapy, and specific behavioral techniques is discussed. Family or marital therapy is seen as the treatment of choice. The psychotherapeutic model proposed is useful in promoting more adaptive coping in the COPD patient.
本文提出了慢性阻塞性肺疾病中适应不良应对的病因，并给出了针对应对能力较差的慢性阻塞性肺疾病患者的心理治疗干预模型。哀伤失败表现为患者期望和目标缺乏转变，导致：1）难以接受与疾病相关的失落感；2）慢性焦虑；3）将情感和行为的责任归咎于外部因素；4）对医疗方案的依从性差。文中讨论了与应对能力较差的患者建立治疗联盟的建议。心理治疗干预旨在：1）促进对失落的接受和生活目标的重新构建；2）中断疏离和社交退缩的循环；3）增强患者对情感唤起和呼吸功能的控制。文中讨论了支持性个体心理治疗、家庭或婚姻治疗以及特定行为技术的应用。家庭或婚姻治疗被视为首选治疗方法。所提出的心理治疗模型有助于促进慢性阻塞性肺疾病患者更具适应性的应对。
