스트레스硏究 : 第 20 卷第 1 號 2012 원저 한국형마음챙김기반스트레스감소프로그램 (K-MBSR) 이암환자의혈압, 심리적증상및삶의질에미치는효과 * 연세대학교의과대학가정의학교실, 이수심리상담센터, 국민건강보험공단일산병원가정의학과, 아주대학교심리학과 이원종 * ㆍ전진수 ㆍ김영성 ㆍ김완석 Effects of Korean Mindfulness-Based Stress Reduction (K-MBSR) on the Blood Pressure, Psychological Symptoms and Quality of Life in Korea Cancer Patients Won-Jong Lee*, Jin Soo Jun, Young-Sung Kim, Wan-Suk Gim *Department of Family Medicine, Yonsei University College of Medicine, Esu Psychological Counseling Center, Seoul, Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Department of Psychology, Ajou University, Suwon, Korea The development in cancer diagnosis and treatment has remarkably increased the survival rate of cancer patients. However, the quality of life of cancer patients has not been considered. In this aspect, Many medical practioners have used mindfulness based stress reduction (MBSR) to care cancer patients in Western countries. There is no study about the effects of MBSR on cancer patients in Korea. Therefore, we analyzed the effects of MBSR on blood pressure, psychological symptom and the quality of life of various cancer patients. We studied 13 subjects with Korean mindfulness based stress reduction (K-MBSR) as a modified MBSR. Blood pressure was measured and SCL-90-R and BDI for psychological symptom and EORTC QLQ C-30 for quality of life were checked by subjects before and after 6 week K-MBSR program, respectively. After the program, systolic, diastolic blood pressure and mean arterial pressures were reduced by 12.7 (p=0.002), 12.0 (p=0.002), and 11.1 mmhg (p=0.001), respectively. In SCL-90-R, obsessive-compulsiveness decreased from 52 to 47 (p=0.02), and anxiety decreased from 49 to 44 (p=0.04). In BDI, no significant changes were showed. K-MBSR significantly improved EORTC QLQ C-30 score of function (increased by 4.4, p=0.01) and quality of life (increased by 25, p=0.02). Our results show that K-MBSR significantly reduces blood pressure, obsessive-compulsiveness and anxiety and improves the quality of life of cancer patients in Korea. (Korean J Str Res 2012;20:1 9) Key Words: Cancer patients, Mindfulness based intervention, Blood pressure, Psyschological symptoms, Quality of life 서 론 책임저자 : 김완석, 경기도수원시영통구원천동산 5 443-749, 아주대학교심리학과 Tel: 031-219-2769, E-mail: wsgim@ajou.ac.kr 접수 : 2012 년 2 월 10 일, 심사 : 2012 년 2 월 24 일게재승인 : 2012 년 3 월 10 일 최근암진단및치료기술의발달로국내의암발생률및주요암의 5년생존율이증가하고있으며이로인해치료중이거나치료가종결된암환자가증가하고있다. 이런가운데암자체가주는다양한육체적인증상과더불어 1
스트레스硏究 : 제 20 권제 1 호 2012 암진단후생긴절망 (frustration), 재발에대한두려움 (fear), 불안 (anxiety) 그리고우울 (depression) 과같은심리적인문제들로인해암환자들의삶의질 (quality of life) 은저하되고있으며이런이유로최근암환자들의삶의질에대한관심이고조되고있다 (Koh KB et al., 1988; Yun YH, 2010). 국외에서는정신신경면역학 (psychoneuroimmunology, PNI) 영역에서암환자의심리적인문제해결및삶의질향상에대한여러가지연구가진행되고있다 (Lutgendorf et al., 2007). 이러한연구는정신사회적인개입 (psychosocial intervention) 을통하여암환자들이느끼는불안, 우울같은심리적인문제해결을통해삶의질을개선시킴은물론암발생및재발과관련된여러면역학적인자 (immunological marker) 의변화를야기시킴으로써장기적으로암환자들의암재발을낮추고생존율을높이고자하는것이다. 실제로, 암환자에대한정신사회적개입이암환자의삶의질과대처능력의향상에효과적이라는것은많은연구들이입증하고있다 (Brown et al., 2007; Ledesma et al., 2009). 한편, 이런개입법들이암의신체생리적측면에도효과가있는가에대해서는아직논란의여지가있지만 (Lutgendorf et al., 2007) 국외의몇몇연구에서는암환자들에게정신사회적인개입을하였을때암재발이줄고생존율이증가했다는결과가나오기도하였다 (Spiegel et al., 1989; Kuchler et al., 1999; Fawzy et al., 2003). 또한암환자들의다양한증상완화, 심리적인문제해결그리고삶의질향상을위해보완대체의학 (complementary and alternative medicine, CAM) 이널리사용되고있으며 (Jung EY et al., 2007; Gansler et al., 2008), CAM의여러영역중심신의학 (mind body medicine) 으로서명상 (meditation) 이널리이용되고있다 (Ock SM, 2006). Kabat-Zinn(1982 & 1990) 은 1970년대말에불교의위빠사나 (vipassana) 명상에서종교적인요소를제거하여환자에게쉽게적용할수있는마음챙김에근거한스트레스감소프로그램 (mindfulness based stress reduction, MBSR) 을개발하였다. MBSR은국외의여러연구에서암환자의심리적인문제해결, 삶의질향상및면역학적인자의개선등에효과가있는것으로나타났다 (Carlson et al., 2003; Witek-Janusek et al., 2008; Lengacher et al., 2009). 최근 MBSR이암환자의정신및신체건강에미치는영향에관한연구들을메타분석한 Ledesma et al.(2009) 는 MBSR이암환자들의암에대한심리사회적적응에효과가있다는결론을내리기도했으며, MBSR은현재국외의 240 개이상의병원에서암을비롯한만성질환의보완적개입 법으로사용되고있다 (McCowen et al., 2010). 국내에서는 MBSR이 Chang HK(2004) 에의해수정보완되어한국형프로그램 (Korean mindfulness based stress reduction, K-MBSR) 으로개발되었으며, 한국인을대상으로그효과가검증되기도하였다 (Bae JH et al., 2006; Chang HK et al., 2007; Kim KW, 2007; Lee BK, 2008). 하지만, 이들연구들은대부분비임상집단을대상으로한연구에국한되어있고암환자등에직접적용한연구는현재까지보고되어있지않다. 이에본연구에서 K-MBSR이암환자의혈압, 심리적인증상그리고삶의질에미치는효과를알아보고이를통해암환자들의삶의질향상을위한방법으로서 K-MBSR의효과성을검증하고자한다. 재료및방법 1. 연구대상암환자를위한한시민단체 ( 암시민연대 ) 의홈페이지에공지를통해자발적으로지원자를모집하였다. 현재정맥으로주입하는약물치료나방사선치료같은항암치료가진행중인사람, 정신과적인문제가있어적절한설문작성이어려운사람, 그리고자립적으로정상생활이불가능한사람은연구에서제외하였다. 총 22명이지원하였으나제외기준을적용하여 19명을선별하였고연구진행도중 6명이자진탈락의사를밝혀총 13명이프로그램을마쳤다. 모든지원자들에게는본연구에대해충분한설명을하였으며프로그램참여동의서를받았다. 또한본연구는해당병원윤리위원회 (Institutional Review Board) 의승인하에진행되었다. 2. 연구방법 1) 한국형마음챙김에근거한스트레스감소프로그램 (K-MBSR): 본연구에서는 K-MBSR 프로그램을사용하였다. K-MBSR은본래 8주짜리프로그램이지만본연구에서는 7회기인종일명상과 8회기인나만의명상만들기를제외한 6주짜리단축형프로그램으로실시하였다. K-MBSR 단축형은한국표본을대상으로하는여러연구들에서효과가있음이검증되었다. 예를들어, 단축형은발표불안과수축기혈압을감소시키며 (Kim MJ, 2007), 경험회피를감소시키는효과가있는것으로나타났다 (Choi HO, 2009). MBSR은공식명상과비공식명상으로이루어져있는데 2
이원종외 3 인 : 한국형마음챙김기반개입법 (K-MBSR) 이암환자의혈압, 심리적증상및삶의질에미치는효과 공식명상은보디스캔 (body scan), 정좌명상 (sitting meditation), 하타요가 (hatha yoga) 와걷기명상 (walking meditation) 으로구성되어있고비공식명상으로먹기명상 (eating meditation), 산명상 (mountain meditation) 그리고일상적인행동에대한마음챙김명상등으로구성되어있다. 한국형으로개발된 K-MBSR은 MBSR을근간으로한것이지만, 뚜렷이다른몇가지특징이있다. 가장큰차이는 K-MBSR은집중명상의수련법이포함되어있다는점인데, K-MBSR의호흡명상 (breath meditation) 에는수식관호흡과기원명상, 진언명상의세종류집중명상법이포함되어있다 (Kim WS, 2010). 본연구에서는한국명상치유학회가인정한 2명의명상치유전문가 (certified professional in meditational healing-registered) 가 6주동안일주일에 1회, 매회당 4시간씩총 24시간의프로그램을진행하였다 (Table 1). 또한프로그램중에배운여러명상법중본인에게맞는명상법을선택하여매일한시간씩명상수행후수행일지를작성하여제출하게하였다. 그리고프로그램개발자의허락을받아 K-MBSR CD를지원자들에게 6주간대여해주었으며연구종료후모두수거하였다. 프로그램이진행되는 6주동안지원자들이복용해오던약의용량이나종류의변화가있을때연구자에게별도의보고를하게하였으며프로그램은 15명에서 20 명이편하게누울수있는공간에서진행되었다. 2) 설문지 : 삶의질측정을위해 EORTC QLQ-C30 (european organization for research and treatment of cancer quality of life questionnaire-core 30) 을사용하였고한국판 EORTC QLQ-C30은 Yun YH et al.(2004) 에의해서신뢰도와타당도가검증되었다. 총 30문항으로기능 (function) 척도 15문항, 증상 (symptom) 척도 13문항, 전반적인삶의질 (quality of life) 에대한평가척도 2문항으로구성되어있다. 기능 (function) 척도는점수가높을수록기능이향상된것을, 증상 (symptom) 척도는점수가높을수록환자가느끼는증상이심한것을, 그리고전반적인삶의질 (quality of life) 은점수가높을수록삶의질이향상됨을각각의미한다 (Yun et al., 2004). 설문지의점수는 EORTC QLQ C-30 scoring manual에의해환산하였다. 본연구에서는지원자들의심리학적인증상의변화를알아보기위해 2가지설문을사용하였는데우울감측정을위해 BDI (Beck depression inventory) 를사용하였다 (Beck et al., 1961). BDI의각각문항은 0점에서 3점으로평가되고전체점수는 0점에서 63점까지로점수가높을수록우울감이심함을나타내며한국판 BDI는 Han HM et al.(1986) 에의해표준화되었다. 다른하나는간이정신진단 Sessions Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Table 1. K-MBSR 6 week program. Contents Participants introduction BP check Lecture: what is MBSR? Eating meditation Body scan Experience sharing and homework check Body scan Breathing meditation Experience sharing and homework check Breathing meditation Sitting meditation 1 Walking meditation Experience sharing and homework check Hatha yoga Sitting meditation 2 Body scan Experience sharing and homework check Hatha yoga Lovingkindness meditation Forgiveness meditation Body scan Sitting meditation 1 Breathing meditation Program review, questionnaire and BP check BP: blood pressure, K-MBSR: Korean mindfulness-based stress reduction. 검사 (symptom check list-90-revision, SCL-90-R) 를사용하였고이는자기보고식증상목록을 Kim JH et al.(1984) 이한국실정에맞게표준화한것이다. 총 90문항으로 9개의하위척도로나뉘고 전혀없다 0점에서 아주심하다 4점으로 5점리커트식척도로평가하게되어있으며점수가높을수록증상이심한것을나타낸다. 본연구에서는 9개의하위척도중암환자들에게흔히나타날수있다고판단되는신체화 (somatization: 12문항 ), 강박증 (obsessive-compulsiveness: 10문항 ), 대인민감성 (interpersonal sensitivity: 9문항 ), 우울 (depression: 13문항 ), 불안 (anxiety: 10문항 ), 적대감 (hostility: 6문항 ) 등 6 개의하위척도만사용하였다. 이상의 3가지설문지를프로그램시작회기와프로그램종료회기에각각시행하였다. 3) 혈압측정 : 혈압은프로그램시작 1주전에 2회, 프로그램첫회기에 2회, 프로그램마지막종료회기때 2회, 프 3
스트레스硏究 : 제 20 권제 1 호 2012 Table 2. Clinical characteristics of subjects a. Characteristics Number (%) Age (year) 50 <50 Sex Male Female Kind of cancer Breast Stomach Colon Tongue Months from diagnosis 45 <45 Stage I II III IV Previous treatment Op Op+Chemo Op+Chemo+Rad Op+Chemo+Hor Op+Chemo+Rad+Hor Past history None Hypertension Diabetes Hypertension+Diabetes Medication No Yes Education High school College Marital status Married Divorced Bereaved Occupation No Yes Previous use of CAM No Yes Religion No Christian Buddhist Catholic 9 (69.2) 4 (30.8) 2 (15) 11 (85) 8 (61.5) 2 (15.4) 2 (15.4) 7 (53.8) 6 (46.2) 2 (30.8) 0 (0) 3 (23.1) 4 (30.8) 10 (76.9) 2 (15.4) 0 (0) 4 (30.8) 9 (69.2) 10 (76.9) 3 (23.1) 11 (84.6) 10 (76.9) 3 (23.1) 8 (61.5) 6 (46.2) Op: operation, Chemo: chemotherapy, Rad: radiation, Hor: hormone, CAM: complementary and alternative medicine. a Data are presented as number (%) unless otherwise indicated. Fig. 1. Comparison of systolic BP, diastolic BP and MAP before and after K-MBSR. p-values are calculated by Wilcoxon signed rank test. BP: blood pressure, MAP: mean arterial pressure, K-MBSR: Korean mindfulness based stress reduction. 로그램종료후 1주일뒤에 2회, 즉프로그램시작전후로각각 4회씩동일한혈압측정기로연구자가직접측정하였다. 혈압은전에 10분에서 20분정도휴식을취한후에참여자개인별로각각측정하였다. 3. 통계분석 모든통계학적분석은 SPSS 17.0 (SPSS inc., Chicago, IL, USA) 로수행하였다. 모든측정값은중앙값 (median) 으로표시하였으며프로그램전후의설문지변화및혈압변화를알아보기위해 Wilcoxon Signed Rank test를시행하였다. p-value는 0.05 미만일때통계적으로의미있는것으로하였다. 결 과 1. 연구대상자의일반적인특성 연구대상자는총 13명 ( 남자 2명, 여자 11명 ) 으로평균연령은 51.7±4.0세였다. 암의종류는유방암 8명 (61.5%), 위암 2명 (15.4%), 대장암 2명 (15.4%) 그리고설암 1명 (7.7%) 이었으며암진단후유병기간은평균 44.1±26.6개월이었다. 연구대상자들의다른일반적인특성은 Table 2에기술하였다. 2. 프로그램전후의혈압변화 Table 3에서보듯이 K-MBSR 시행전에비해시행후수축기 (systolic) 혈압, 이완기 (diastolic) 혈압그리고평균동맥압 (mean arterial pressure, MAP) 에서유의한감소가있었다 ( 각 4
이원종외 3 인 : 한국형마음챙김기반개입법 (K-MBSR) 이암환자의혈압, 심리적증상및삶의질에미치는효과 Table 3. Comparison of systolic BP, diastolic BP and MAP before and after K-MBSR a. BP (mmhg) Before K-MBSR After K-MBSR p b Systolic BP Diastolic BP MAP 130.5 (112.3 157.5) 84.3 (68.5 98.8) 99.2 (83.1 118.3) 117.8 (104.8 153.8) 72.3 (64.8 100.0) 88.1 (79.1 117.9) 0.002 0.002 0.001 BP: blood pressure, MAP: mean arterial pressure, K-MBSR: Korean mindfulness based stress reduction. a Data are presented as median (minimum-maximum) unless otherwise indicated, b p-values are calculated by Wilcoxon Signed Rank test. Fig. 2. Comparison of SCL-90-R score before and after K-MBSR. p-values are calculated by Wilcoxon signed rank test. SCL-90-R: symptom checklist-90-revision, SOM: somatization, OC: obscessive-compulsiveness, IS: interpersonal sensitivity, DEP: depression, ANX: anxiety, HOS: hostility. 각 p=0.002, p=0.002, p=0.001). 3. 프로그램전후의증상변화 Table 4에프로그램전후의증상변화를요약하였다. K-MBSR 시행전에비해시행후 SCL-90-R에서강박 (obsessive-compulsiveness) 과불안 (anxiety) 에서유의한감소소견 ( 각각 p=0.02, p=0.04) 을보였으나다른항목들에서는유의한변화가없었다. 또한 BDI에서는유의한변화가없었다 (p=0.05). EORTC QLQ C-30 설문의기능 (function) 척도에서유의한기능의향상 (p=0.01) 이있었으며, 전반적인삶의질 (quality of life) 항목에서도유의한삶의질향상이있었다 (p=0.02). 그러나증상 (symptom) 척도에서는유의한변화가없었다 (p=0.08). 고 본연구에서는 K-MBSR 프로그램을시행하기전에비해시행후스트레스받을때상승할수있는혈압이유의하 찰 게감소하였고 (Pyun KH et al., 2005), 암환자들이느끼는강박과불안이유의하게감소하였으며삶의질또한유의하게향상되는결과가나타났다. Carlson et al.(2007) 은유방암환자에대한 MBSR의효과연구를통해, 8주간의 MBSR 프로그램종료후에측정한수축기혈압이시행전에비해유의하게감소한다는결과를보고하였다. 이런결과는본연구의결과와일치한다. 또한, 2형당뇨환자를대상으로 Rosenzweig et al.(2007) 이시행한연구에서 8주간의 MBSR 프로그램시행후 4주뒤에추적관찰하여측정한평균동맥압이통계적으로유의한 (p= 0.009) 감소가나타났다. 본연구가 Rosenzweig et al.(2007) 의연구와비교해연구대상군, 연구기간등이다소다르기는하지만혈압이유의하게감소한다는점에서그들의결과와일치하고있다. Lengacher et al.(2009) 의연구에서는 MBSR 시행후에불안 (anxiety) 과우울 (depression) 이동시에호전되는결과가나타났다. 우선적으로본연구에서는 SCL-R-90의하위척도중강박과불안감이감소하는결과가나타났는데, 강박과불안은정신과적으로불안장애 (anxiety disorder) 의범주에속한다는사실로미루어볼때 K-MBSR이암환자의불안을감소시키는효과가있음을강하게보여준다. 그러나이번연구와 Lengacher et al.(2009) 의연구의다른점은본연구에서사용한우울측정설문들에서는유의한결과가나오지않았다는것이다. 이는본연구에서 K-MBSR 시행전의우울측정설문들의점수가낮게측정된것이그원인이라고생각된다. 그러나국외의여러연구들 (Carlson et al., 2003; Carlson et al., 2007; Rosenzweig et al., 2007; Sephton et al., 2007) 에서는암환자및다른종류의질환을가진환자에게 MBSR을적용하였을때우울측정설문에서유의한우울의감소가있는점으로보아추후장기적인추적관찰을시행하거나 BDI 점수가높은암환자를선별하여연구를시행한다면유의한결과가나올가능성을배제할수없다. 삶의질에대해서는 Lengacher et al.(2009), Witek-Janusek et 5
스트레스硏究 : 제 20 권제 1 호 2012 Table 4. Comparison of BDI, SCL-90-R and EORTC QLQ C-30 before and after K-MBSR a. Questionnaire Before K-MBSR After K-MBSR p b BDI SCL-90-R Somatization Obscessive-compulsive Interpersonal sensitivity Depression Anxiety Hostility EORTC QLQ C-30 Function Symptom Quality of life 12 (4 23) 47 (37 70) 52 (38 65) 53 (38 65) 49 (36 64) 49 (39 61) 44 (41 62) 68.9 (42.2 86.7) 25.7 (12.8 46.2) 58.3 (16.7 91.7) 8 (0 29) 46 (38 78) 47 (35 62) 47 (37 71) 46 (36 72) 44 (38 58) 42 (41 64) 73.3 (62.2-93.3) 23.1 (5.1 69.2) 83.3 (41.7 100.0) 0.05 0.78 0.02 0.12 0.18 0.04 0.10 0.01 0.08 0.02 BDI: Beck depression inventory, SCL-90-R: symptom check list-90-revised, EORTC QLQ C-30: European organization for research and treatment of cancer quality of life questionnaire-core 30, K-MBSR: Korean- mindfulness based stress reduction. a Data are presented as median (minimum-maximum) unless otherwise indicated, b p-values are calculated by Wilcoxon Signed Rank test. Fig. 3. Comparison of EORTC QLQ C-30 score before and after K-MBSR. p-values are calculated by Wilcoxon signed rank test. EORTC QLQ C-30: European organization for research and treatment of cancer quality of life questionnaire-core 30, K-MBSR: Korean mindfulness based stress reduction, QOL: quality of life. al.(2008), Carlson et al.(2003 & 2007) 과같은국외의연구들처럼삶의질이향상되는결과가나타났다. 그러나본연구에서사용한 EORTC QLQ C-30의증상 (symptom) 척도에서는유의한결과가나오지않았는데이러한결과는국외의 Cralson et al.(2003) 이시행한연구에서증상척도가유의한결과를보이지않은것과일치한다. 본연구의결과를가능하게한명상의생물학적기전에대해아직확실히밝혀져있지는않다. 그러나명상중에혈청코티졸 (cortisol) 이감소하고 β-아드레날린성수용체 (beta-adrenergic receptor) 의수가감소하여교감신경계의아드레날린성수용체 (adrenergic receptor) 의민감성이둔화되며또한세로토닌 (serotonin) 의생성을높여수면과같은이완상태가유도된다는등의사실 (Chang HK, 1996) 이알려져있다. 또한뇌파및기능적자기공명영상기록 (functional magnetic resonance image, fmri) 장치를이용한최근의연구결과를 (Creswell et al., 2007; Holzel et al., 2011) 고려하여종합해보면명상은과다한교감신경계의기능을일방적으로낮추는것만이아니라부교감신경을활성화시키며중추신경계의기능을통합시켜우리몸의항상성을유지한다고볼수있다 (Chang HK, 1996). 본연구는 K-MBSR이라는마음챙김명상을기반으로하는건강개입법을암환자에게적용한우리나라최초의연구라는점에서큰의미가있다. 또한치료가종결되어더이상병원으로부터적극적인관심을받지못하는많은암환자들이암재발억제와생존율향상을위해과학적으로검증되지않은여러보완대체의학적인방법을사용하고있는우리나라의현실을고려할때 (Jung EY et al., 2007), 한가지암종에국한하지않고여러암종의환자를대상으로시행한본연구가적은표본수와짧은연구기간에도유의한결과가나왔다는점에서의미가있다. 물론본연구는무선화대조집단을적용하지못한연구이기때문에예비연구라는성격이더크기는하지만, 미국에서개발된 MBSR을한국인에게적합한방식으로수정한 K-MBSR의효과검증이그동안주로비임상집단을대상으로이루어졌다는점을감안하면, 만성질환에대한 K-MBSR의의료적 6
이원종외 3 인 : 한국형마음챙김기반개입법 (K-MBSR) 이암환자의혈압, 심리적증상및삶의질에미치는효과 적용가능성을보여주는것이라볼수있다. 향후임상연구에서자주부딪히게되는문제들을극복하여무선통제집단을채용하고, 표본수를더늘이며, 추수측정까지하는더나은실험설계가필요하다는것은자명한일이다. 그외에도스트레스호르몬, 자율신경계의활성도, 면역학적인자의변화등신체생리지표에대한효과를검증하고, 정신사회적개입이암환자의장기생존율과재발에미치는효과등에대해서도연구가진행되어야할것이다. 또한 MBSR이다양한만성질환의증상개선에도그효과가있음이보고되었기에 (Brown et al., 2007; Lidesma et al., 2009) 앞으로국내의다양한만성질환자들, 예를들어, 당뇨병, 갑상선, 심혈관계질환등을대상으로하는연구도진행될필요가있다. 한편, K-MBSR은 MBSR과프로그램을구성하는요소들에서특징적인차이가있는바, MBSR이마음챙김명상기법만을포함하고있는것에비해 K-MBSR은그외에집중명상기법까지포함하고있다. 또한두프로그램모두정적인명상법 ( 정좌명상, 호흡명상, 바디스캔등 ) 뿐아니라동적인명상 ( 하타요가와걷기명상등 ) 도포함하고있어서그구성요소들이매우다양한바, 각각의구성요소들의차별적효과를검증하는연구가필요할것이다. 결론적으로본연구는한국형마음챙김에근거한스트레스감소프로그램 (K-MBSR) 이암환자들의혈압을감소시키고암환자의강박과불안과같은심리적증상을감소시키며삶의질을의미있게향상시킬수있음을보여줌으로써연구설계의한계에도불구하고 K-MBSR의의료적적용의가능성을보여준것이라생각한다. 참고문헌 Bae JH, Chang HK (2006) The effect of MBSR-K program on emotional response of college students. The Korean Journal of Health Psychology 11:673-688. Beck AT, Ward CH, Mendelson M et al. (1961) An inventory for measuring depression. Arch. Gen. Psychiatry 4:561-571. Brown KW, Ryan RM, Creswell JD (2007) Mindfulness: theoretical foundations and evidence for its salutary effects. Psychological Inquiry 18:211-237. Carlson LE, Speca M, Faris P et al. (2007) One-year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior & Immunity 21:1038-1049. Carlson LE, Speca M, Patel KD et al. (2003) Mindfulness based stress reduction in relation to quality of life, mood, symptom of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom. Med. 65:571-581. Chang HK (1996) A psychological study on meditation: psychophysiological characteristics of meditation. The Korean Journal of Health Psychology 1:15-33. Chang HK (2004) Therapeutic application of meditation to the stress-related disorders. The Korean Journal of Health Psychology 9:471-492. Chang HK (2009) Mind vs Brain: train your mind, change your brain. 1st ed. P222-231. Bulkwang Co., Seoul. Chang HK, Kim JM, Bae JH (2007) The development of Korean version of mindfulness-based stress reduction program and the effects of the program. The Korean Journal of Health Psychology 12:833-850. Choi HO (2009) The effects on the K-MBSR on PTSD symptoms, experiential avoidance, and shame in North Korean defectors. [dissertation]. Chonbuk National University, Jeonju. Creswell JD, Way BM, Eisenberger NI et al. (2007) Neural correlates of dispositional mindfulness during affect labeling. Psychosom. Med. 69:560-565. European Organization for Research and Treatment of Cancer [Internet]. (2010) Belgie: European Organization for Research and Treatment of Cancer; [cited 2010 July 14]. Available from: http://www.eortc.org Fawzy FI, Canada AL, Fawzy RN (2003) Malignant melanoma: effects of a brief, structured psychiatric intervention on survival and recurrence at 10-year follow up. Arch. Gen. Psychiatry 60:100-103. Gansler T, Kaw C, Crammer C et al. (2008) A population-based study of prevalence of complementary methods use by cancer survivors. Cancer 113:1048-1057. Hahn HM, Yum TH, Shin YW et al. (1986) A standardization study of Beck depression inventory. Korea J. Korean Neuropsychiatr Assoc. 25:487-502. Holzel BK, Carmody J, Vangel M et al. (2011) Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research:Neuroimaging 191:36-43. Jung EY, Han DW, Choi BH et al. (2007) Use of complementary and alternative medicine among cancer patients in Korea. Korean J. Oriental Physiology & Pathology 21:1590-1596. Kabat-Zinn J (1982) An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry 4:33 47. Kabat-Zinn J (1990) Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte 7
스트레스硏究 : 제 20 권제 1 호 2012 Press, New York. Kabat-Zinn J, Lipworth L, Burney R (1985) The clinical use of mindfulness meditation for the self regulation of chronic pain. J. Behav. Med. 8:163-190. Kim JH, Kim KI (1984) The standardization study of symptom checklist-90-revision in Korea III. Mental Health Research 2:278-287. Kim KW (2007) The effect of an 6-week mindfulness-based stress reduction-korea for short version program on the stress response and the quality of life in college students [dissertation]. Yeungnam University, Gyeongsan. Kim MJ (2007) Effects of K-MBSR progrma on speech anxiety of university students. [dissertation]. Yeungnam University, Gyeongsan. Kim WS (2010) A comparative review on K-MBSR and MBSR: implications for the establishment of K-MBSR. Korean Journal of Meditational Healing 1:17-42. Koh KB, Kim ST (1988) Coping strategy of cancer patients. J. of Korean Neuropsychiatr. Ass. 27:140-148. Kuchler T, Henne-Bruns D, Rappat S et al. (1999) Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. Hepatogastroenterology 46:322-335. Lee BK (2008) The effects of Korean MBSR (mindfulness-based stress reduction) on depression, mindful attention awareness, and absorption in university students. The Korean Journal of Clinical Psychology 27:333-345. Lengacher CA, Johnson-Mallard V, Post-White J et al. (2009) Randomized controlled trial of mindfulness-based stress reduction for survivors of breast cancer. Psycho-Oncology 18:1261-1272. Lindesma D, Kumano H (2009) Mindfulness-based stress reduction and cancer: A meta-analysis. Psycho-Oncology 18:571-579. Lutgendorf SK, Costanzo ES, Siegel SD (2007) Psychosocial influence in oncology: an expanded model of biobehavioral mechanism. In: Robert Arder, editor. Psychoneuroimmunology. 4th ed. P869-895. Elsevier Academy Press, Burlington. McCowen D, Reibel D, Micozzi MS (2010) Teaching Mindfulness: A Practical Guide for Clinicians and Educators. Springer, New York. National Cancer Information Center [Internet]. Korea: National Cancer Information Center; c2008 [cited 2010 July 14]. Available from: http://www.cancer.go.kr Ock SM (2006) Clinical application of mind-body medicine. J. Korean Acad. Fam. Med. 27:79-90. Pradhan EK, Baumgarten M, Langenberg P et al. (2007) Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis. Rheum. 57:1134-1142. Pyun KH, Chang HK (2005) Mind body medicine. 1st ed. P42-45. Hakjisa Publisher, Seoul. Rosenzweig S, Reibel DK, Greeson JM et al. (2007) Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Altern. Ther. Health. Med. 13:36-37. Sephton SE, Salmon P, Weissbecker I et al. (2007) Mindfulness meditation alleviates depressive symptom in women with Fibromyalgia: result of a randomized clinical trial. Arthritis. Rheum. 57:77-85. Spiegel D, Bloom G, Kramer J et al. (1989) Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2:888-891. Witek-Janusek L, Albuquerque K, Chroniak KR et al. (2008) Effect of mindfulness based stress rduction on immune function, quality of life and coping in women newly diagnosed with early breast cancer. Brain Behav. Immun. 22:969-981. Yun YH. (2010). Common primary cancer issues among cancer survivors; quality of life. J. Korean Acad. Fam. Med. 31:S232. Yun YH, Pakr YS, Lee ES et al. (2004) Validation of the Korean version of the EORTC QLQ C-30. Qual. Life Res. 13:863-868. 8
이원종외 3 인 : 한국형마음챙김기반개입법 (K-MBSR) 이암환자의혈압, 심리적증상및삶의질에미치는효과 = 국문초록 = 암진단및치료기술의발달로암유병률및암생존율이증가하고있다. 이런이유로최근암환자의심리적인문제해결및삶의질향상에대한관심이고조되고있다. 국외에서는 Kabat-zinn 이개발한마음챙김에근거한스트레스감소프로그램 (mindfulness based stress reduction: MBSR) 을암환자들에게적용하여삶의질을높이려는연구가시도되고있지만국내에서는이에대해아직보고된바가없다. 따라서본연구에서는장현갑이 MBSR 을변형하여개발한한국형마음챙김에기반한스트레스감소프로그램 (Korean mindfulness based stress reduction: K-MBSR) 을암환자에게적용하여 K-MBSR 이암환자의혈압, 심리학적인증상그리고삶의질에미치는효과를알아보고자한다. 총 13 명이 6 주의 K-MBSR 프로그램을종결하였으며혈압, 심리적증상변화에대해 BDI, SCL-90-R 그리고삶의질변화에대해 EORTC QLQ C-30 을프로그램전후에각각측정하였다. 6 주간의 K-MBSR 을시행후혈압은수축기혈압 (p=0.002), 이완기혈압 (p=0.002), 평균동맥압 (p=0.001) 에서모두유의한감소가있었다. SCL-90-R 에서강박 (p=0.02) 과불안 (P=0.04) 의유의한감소가나타났으나 BDI (p=0.05) 에서는유의한감소를보이지않았다. 또한 EORTC QLQ C-30 의기능척도 (p=0.01) 와전반적인삶의질 (p=0.02) 에서는유의한향상이나타났으나증상척도 (p=0.08) 에서는유의한변화가없었다. 한국형마음챙김에기반한스트레스감소프로그램 (K-MBSR) 은암환자의혈압및다양한심리적인증상중강박, 불안을유의하게감소시키고암환자의삶의질을유의하게향상시킨다. 중심단어 : 암환자, 마음챙김기반개입법, 혈압, 심리적증상, 삶의질 9