宗教認知行為療法融入高齡靈性照顧

Integrating Religious Cognitive-Behavior Therapy Into Spiritual Care for Older Adults

背景：許多國外研究顯示了宗教認知行為療法（R-CBT）的成效，但臺灣在長照服務領域中，對此項療法的認知尚未普及。目的：本文旨在描述被證實為有效的宗教照顧內容與措施，並依此提出可行的靈性照顧建議，以呼應政府長照政策對高齡靈性健康的重視。方法：彙整以宗教、靈性照顧、宗教認知行為治療為主題，以英文撰寫之研究，分析以宗教為核心的靈性照顧如何幫助個案運用自己熟知的宗教信仰，改變認知與行為，提高困境因應的能力、促進生活滿意度與幸福感。結果：宗教認知行為療法在許多國家被普遍運用於病人、家屬與高齡者之靈性照顧，它整合宗教教義、儀式活動、經典、象徵物及宗教故事等，幫助個案進行認知重組，以期改變個案之認知與行為，進而改變負面心理與情緒狀態。五大重要內容與步驟為：一、心理與宗教評估；二、提供認知心理及宗教改變非理性信念與行為之教育課程；三、運用宗教信念與價值觀提升康復動機；四、提供宗教倫理觀改變信念與行為；五、鼓勵運用宗教儀式或參與宗教活動。結論與建議：將宗教與認知行為療法結合，被證實可以改善各種疾病患者與高齡者的心理與情緒狀態，甚至比傳統的認知行為療法可以更有效地幫助罹患情緒問題與憂鬱的病人。文末針對高齡靈性照顧的教育、臨床照顧實務工作與進一步研究等三方面提出建議，以強化國人在宗教認知行為療法的照顧觀念，並將此作為促進高齡者靈性健康的一種品質成效。

Background: Many studies have shown the efficacy of Religiously Integrated Cognitive Behavior Therapy (RCBT), but awareness of this therapy has not yet become widespread in the field of long-term care services in Taiwan. Purpose: This article aims to describe the content and measures of religion based spiritual care andto propose it for the elderly in long-term care. Methods: Comprehensive research on the themes of religion, spiritual care, and RCBT, and analyzed how putting religion at the core of spiritual care can help patients by using their familiar religious beliefs, rituals etc. to change their cognition and behavior, and improve their ability to cope with difficulties, to improve life satisfaction and wellbeing. Results: RCBT is the common ways to provide spiritual care for patients and the elderly in many countries. It integrates religious teachings, ritual activities, scriptures, symbols and stories to helps patients identify the underlying beliefs that contribute to negative thoughts, allowing them to understand their thought patterns and recognize how these patterns influence their negative emotions and behaviors, and then to change them. There are five notable RBCTs include: (1) psychological and religious assessment; (2) providing educational courses on cognitive psychology and religion to change irrational beliefs and behaviors; (3) improving motivation for recovery; (4) providing religious values and ethics to change beliefs and behaviors; (5) Encourage the use of religious rituals or participation in religious activities. Conclusion and Suggestions: Combining religion with cognitive behavioral therapy has been proven to improve the psychological and emotional state of patients with various diseases and the elderly. It can even help patients suffering from emotional problems and depression more effectively than traditional cognitive behavioral therapy. Finally, we suggest some ideas that can inform spiritual care education,clinical practices and future research.