• 대한교통학회지
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• 제29권1호
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• pp.57-67
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• 2011

본 연구는 교통사고 야기자의 PTSD(Posttraumatic Stress Disorder) 발생 구조와 원인, 치료방법 선택에 기초적인 자료를 제공하기 위하여 연구를 진행하였다. 연구 결과, 첫째, 교통사고 피해자가 아닌 가해자를 대상으로 추정만 하던 교통사고 가해자의 PTSD 현황을 전국적인 설문조사를 통하여 파악할 수 있었다. 둘째, 교통사고 야기자를 대상으로 교통사고의 발생과 밀접한 20가지의 운전 상황에서 교통사고 이후의 운전태도 변화를 요인분석으로 3가지로 유형화할 수 있었다. 셋째, PTSD 유 무별로 주요 운전 상황에서의 운전태도 변화의 차이가 있음을 t검정을 통하여 파악할 수 있었다. 또한 t검정을 통하여 유의하다고 나타난 6가지의 운전 상황을 구조방정식 모형에 적용하여 PTSD 관련 변수와 운전태도 변화와의 관계를 분석하는 모형을 구축할 수 있었다. 구축된 모형의 분석을 통해, PTSD 저감 예방을 위한 대책 마련 및 PTSD 저감을 위한 기초자료를 제공하였다.

• 대한불안의학회지
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• 제8권2호
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• pp.106-112
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• 2012

Objective : In posttraumatic stress disorder (PTSD), it is essential to evaluate the severity of trauma with a reliable instrument. The combat exposure scale (CES) is one of the most widely used measures for the combat-related trauma. The present study was conducted to test the reliability and validity of the Korean version of CES (CES-K). Methods : One hundred and forty-five male Korean veterans of the Vietnam War participated in this study. CES-K, the structured clinical interview for DSM-III-R (SCID), clinician administered PTSD scale (CAPS), and the Korean version life events checklist (LEC-K) were administered. Results : Cronbach's coefficient of CES-K was .85, and the test-retest reliability was .94. The mean [standard deviation (SD)] scores of CES-K were 20.4 (9.0) in the PTSD group and 12.0 (8.6) in the non-PTSD group (p<.001). CES-K showed a significant correlation with LEC-K (r=.31, p<.001) and CAPS (r=.52, p<.001). Only one factor was revealed by the factor analysis. Conclusion : CES-K showed good reliability and validity for assessing the severity of combat exposure. Further, it demonstrated comparable psychometric properties to the previous study. It is expected that CES-K will be a useful tool for evaluating the severity of combat exposure in Korea.

• 대한불안의학회지
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• 제4권1호
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• pp.55-61
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• 2008

Objective : Eye movement desensitization and reprocessing (EMDR) has been established as an effective treatment for patients with posttraumatic stress disorder (PTSD). However, the literature is unclear as to whether EMDR is effective in the treatment of other psychiatric disorders. The purpose of this study was to evaluate the potential use of EMDR in the treatment of psychiatric disorders other than PTSD by using a clinician's impression of patient response and a subjective symptom evaluation. Methods : Seventeen diagnostically heterogenous patients without PTSD underwent an average of 4.3 sessions of EMDR. Symptom severity was assessed by the Clinical Global Impression-Change Scale (CGIC), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Symptom Checklist-90- Revised (SCL-90-R) before and after EMDR. Those whose CGI-C scores were 'very much improved' and 'much improved' after EMDR were classified as 'responders.' The patients' before and after treatment scores of symptom severity and group differences were compared. Results : Twelve of the 17 participants (12/17, 71%) were classified as 'responders.' The patients' scores on all of the scales, with the exception of the trait anxiety scale and obsession-compulsion scale of the SCL- 90-R, significantly decreased after treatment. There was no difference in sociodemographic and clinical variables between the responders and non-responders. Conclusion : The results of our study suggest that EMDR can be a promising candidate for the treatment of patients with psychiatric disorders other than PTSD, and thus further controlled studies are needed to determine whether EMDR can be applied to various psychiatric populations.

• 생물정신의학
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• 제18권2호
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• pp.80-89
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• 2011

Pavlovian fear conditioning has been extensively studied for the understanding of neurobiological basis of memory and emotion. Pavlovian fear conditioning is an associative memory which forms when conditioned stimulus (CS) is paired with unconditioned stimulus (US) once or repeatedly. This behavioral model is also important for the understanding of anxiety disorders such as posttraumatic stress disorder. Here we describe the neural circuitry involved in fear conditioning and the molecular mechanisms underlying fear memory formation. During consolidation some memories fade out but other memories become stable and concrete. Emotion plays an important role in determining which memories will survive. Memory becomes unstable and editable again immediately after retrieval. It opens the possibility for us of modulating the established fear memory. It provides us with very efficient tools to improve the efficacy of cognitive-behavior therapy and other exposure-based therapy treating anxiety disorders.

• 생물정신의학
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• 제17권2호
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• pp.79-85
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• 2010

Objectives : Trauma patients have attentional bias which enforces traumatic memories and causes cognitive errors. Understanding of such selective attention may explain many aspects of the posttraumatic stress disorder(PTSD) symptoms. Methods : We used the rapid serial visual presentation(RSVP) method to verify attentional blink in burn patients with PTSD. International affective picture system(IAPS) was used as stimuli and distracters. In the 'neutral test', patients have been presented series of pictures with human face picture as target stimuli. Each picture had 100ms interval. However the distance between target facial pictures was randomized and recognition of second facial picture accuracy was measured. In the 'stress test', the first target was stress picture which arouses patient emotions instead of the facial picture. Neutral and Stress tests were done with seven PTSD patients and 20 controls. In '85ms test' the interval was reduced to 85ms. The accuracy of recognition of second target facial picture was rated in all three tests. Eighty-five ms study was done with eighteen PTSD patients. Results : Attentional blinks were observed in 100-400ms of RSVP. PTSD patients showed increased recognition rate in the 'stress test' compared with the 'neutral test'. When presentation interval was decreased to 85 ms, PTSD patient showed decrease of attentional blink effect when target facial picture interval was 170ms. Conclusion : We found attentional blink effect could be affected by stress stimulus in burn patients. And attentional blink may be affected by stimulus interval and the character of stimulus. There may be some other specific mechanism related with selective attention in attentional blink especially with facial picture processing.

• 대한불안의학회지
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• 제8권2호
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• pp.93-98
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• 2012

Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.

• 한국융합학회논문지
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• 제6권2호
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• pp.13-18
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• 2015

본 연구의 목적은 소방공무원의 외상후 스트레스 장애의 원인을 파악하고 스트레스를 진단하기 위한 척도와 도구에 대한 고찰을 통해 위기상황 스트레스 관리 교육프로그램과 대책을 제안하고자 하는데 그 목적이 있다. 외상후 스트레스 장애는 침습 증상, 회피 증상, 인지와 기분의 부정적 변화, 과각성 증상을 특징을 포함한다. 트라우마의 기억은 외현 기억(explicit memory)과 암묵 기억(implicit memory)이 있다. 외현 기억은 의식적, 인지적, 서술적이며, 변연계 구조물 중 해마가 관여한다. 사건 당시 정보 처리는 억제적이며, 내러티브 언어구성을 갖는다. 암묵 기억은 무의식적, 정서적, 절차적이며, 몸이 기억을 한다. 관련된 변연계 구조물은 편도체이고 사건 당시 정보처리는 활성화되어 있고, 말로 표현할 수 없는 언어구성을 갖는다. 암묵 기억의 소거가 트라우마 치료에서 가장 중요하다. 위기상황 스트레스 관리(critical incident stress management, CISM)는 위기 상황으로 인해 발생되는 스트레스의 유해성을 감소시키고, 조절하기 위한 포괄적이고 체계적인 접근 방법이다. 결론적으로 CISM의 핵심적 목표는 외상후 스트레스 장애에 의한 심리적 상태의 종결이라고 할 수 있다. 본 연구는 외상후 스트레스 장애의 원인과 대처방법에 대한 문헌 고찰을 통해 소방공무원의 외상후 스트레스 장애 해소를 위한 교육프로그램 개발을 제안하고자 하였다.

• 대한불안의학회지
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• 제12권2호
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• pp.69-78
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• 2016

Objective : Disaster causes psychological distress to a large number of people in a short period of time, by both direct and indirect exposure to traumatic events embedded in various realms of disaster experience. Optimal, well-planned treatment interventions should follow from the early acute period to recovery phase, extending up to several months later. In this context, there is an increasing need for systemic review to gain comprehensive insights for disaster interventions. These need to be added to public policy, and for the prevention and treatment of disaster-related psychopathology. Here, we review the published studies on psychological interventions for disaster-related posttraumatic stress disorder. Methods : Specific psychological interventions regarded as effective treatments for have been selected for this review, such as CBT (Cognitive-Behavior Therapy), Exposure Therapy, EMDR (Eye Movement Desensitization & Reprocessing), SIT (Stress Inoculation Therapy) and Psychoeducation. In addition, natural disasters, industrial disasters, and accidents involving aircraft and ships were also categorized as disasters, along with war and combat trauma. Results : Cognitive behavior therapy and exposure therapy had the strongest research support for effectiveness, and could be considered as the first-choice treatment for disaster-related PTSD. The second line of treatment is EMDR, although this treatment modality has the advantage of reaching certain treatment improvements in fewer sessions. However, the effects of SIT and psychoeducation to the survivors of disasters, remains unclear at this point. Additionally, we propose the possibilities of using virtual reality component and imagery rescripting as modified forms of traditional cognitive behavior therapy and exposure therapy. Conclusion : Cognitive behavior therapy and exposure therapy, deemed effective treatments for various trauma, are considered to be effective for survivors from disasters. However, the efficacy of other interventions has not yet been examined methodologically in well-designed studies, such as randomized controlled trials. In particular, future empirical studies are needed, since it is difficult to conclude that psychological interventions have similar effects on different types of disasters.

• 동의신경정신과학회지
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• 제22권4호
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• pp.77-86
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• 2011

Objectives : These days assaults and other natural and human disasters are increasing. But oriental medical treatment researches in Korea are limited in car accident PTSD patients only. Our object is to explore an oriental medical intervention model for the evidence-based approach to PTSD after diverse trauma including disasters. Methods : Domestic papers for Korean researches are obtained from oriental medical related journals by internet searching. International materials are obtained from PubMed searching and a publication from Department of Veterans' Affairs. After assorting searched articles into RCTs and non-RCTs, we analyzed the articles according to the elapsed time from trauma. Results : We confirmed that acupuncture, CBT, and PMR were effective in acute stage after traumatic event. And EMDR, EFT, and relaxation therapy were effective in chronic stage after traumatic event. Building on the findings, we proposed a model of oriental medicine for Disaster Mental Health. Conclusions : Analyzing previous researches about oriental medicine on PTSD, several interventions were confirmed the effectiveness on specific treatment stage. We could find the possibility of Oriental Medicine as a Disaster Mental Heath and proposed a model of Oriental medicine for Disaster Mental Health.

• 한국의사학회지
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• 제34권1호
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• pp.59-74
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• 2021

Li Gao left a great mark in the history of Chinese medicine by founding Piwei (脾胃) theory. When explaining Li Gao's medical ideology, researchers explain that his medical ideology was created by curing hunger during wartime and treating diseases of people who suffered from battle field trauma. However, Li Gao also suffered from battlefield trauma for his experience of the Mongol siege of Kaifeng (開封城) from 1232 to 1233. It is the hypothesis of this study that Li Gao himself would have suffered posttraumatic stress disorder (PTSD), and this study reexamines the process more closely from the viewpoint of PTSD and posttraumatic growth (PTG). The conclusion of this study is that his achievement in medical history is a result of his PTG. Li Gao's narrative of Piwei (脾胃) theory contains elements that seek revenge against the Mongol soldiers, and Li Gao achieved extraordinary PTG by overcoming the trauma of the siege of Kaifeng step by step.