Bước đầu xây dựng mô hình hành vi nhận thức trong trị liệu rối loạn lo âu cho trẻ vị thành niên

TAM Ll H9C • iiMH tl Hpe iijr* n6i

BirdC DAU XAY DUNG MO HJNH HANH VI - NHAN THUC
TRONG TRI LIEU fk LOAN LO AU CHO TRE Vj THANH NIEN
Q

1 . Lx> du Id mdl h-ong nhOng rdi loqn tdm If
diln hinh, dde bilt ddi vdl tudi hgc sinh (HS) hung
hqc phd thdng (THPT) h> 15-18 hjdl. Dd hjdl ndy
Id ihdl ki hodn ihl^n phdt h l l n t h i chdt cOa con
ngudi v l cd phuong dl|n cdu tqo vd chiic ndng.
Ddy Id thdt ki sung mdn nhdt ciia dai ngudi nhung
cdc em k;ii g$p phdi nhilu vdn d l lidn quon d i n
lo du: hqc h^p, bgn bd, hinh dnh bdn thdn ciio
hl|n h;il vd tuong lai, Hnh ydu ddi liia, nht^g vdn
d l v l gio dinh, nhDng kl vgng md gio dinh vd bdn
thdn h/ d£^ ra. Dd chfnh nhOng k) du binh ihudng
md bdt Cli ngudi trudng thdnh ndo cung phdi trdi
qua. Tuy nhidn, b du diln ra aud miic sS dnh hudng
oIn ede chuc ndng v l m ^ xd ndi nhu cdng v i ^ hqc
tdp, gloo tilp. N ^ qud n^ng b ^ h nhdn sd bj tdn
tdt v l mat xa hdi. Dllu hi cho b ^ h nhdn ed rdi bgn
b du dqt duqc hlfu qud thdng qua v i ^ dCmg thudc
vd Irj hdu bdng hdnh vl - nhdn thiic. Phuong phdp
hi lidu bdng hdnh vl - nhdn thiic cd Idc dqng din
gido dye v l tdm li, hudng ddn b ^ h nhdn edeh xii If
nhung bilu hidn cua b du, hodng sg. Hodc dugc
cung cap \^ phdp phoi nhilm Y£A nhDng ylu td
gdy eho bdnh nhan b du, d l tu dd thfch nghi duqc
vdl nhung hoan cdnh gdy ra tinh trqng b au vd cdc
hidu chiing s3 ddn mdt di.

HUYNH H 6 NGQC ANH*

1) Thang do sg hdi. Module ndy Id thilt lOp
danh sdeh cdc y l u id sg hdi mdl cdch cd hinh ty
vd trdnh ldm cho b ldng tdng thdm. Thyc l l nd c6
t h i tdt hon d l md ta thang do sg hai nhu la cdch
do ludmg sy lo ldng cDa mdt ngudi hodc miic dd
sg hai. Thilt ldp danh sdeh cdc tdc nhdn kfch thfch
gdy sg hdi trong phqm vl chdn dodn ban ddu
hodc nhDng vdn d l chinh y l u . Ddi vdl vdn d l
chfnh ciia chdn dodn, xdc djnh cdc h k nhdn kfch
thfch gdy sg hdi cdng nhilu cdng tdt (Hnh hudng,
edm gidc, ndi dm dnh, h'n hi^u). Cdn h?o ra sy
da dqng nhung phdi ludn ndm Irong myc tidu
chfnh (hie Id nhung vdn d l dd sd Id myc Hdu cOo
h-j ll^u). Xdc djnh miie dd vd sdp x I p cdc vdn d l
hi thdp d i n coo.

2) Hgc vi lo 6u. Ddy Id nuxlule hgt nhdn eiia
h*! lidu lo du, chu y l u gido dye than chu v l b du,
truyin cho thdn chu sy [gc quan v l nhijng Hnh
hudng eua chinh bdn thdn. Ti> dd khuyin khtch
thdn chu tham gio h^ ll^u. Gldl thfch b du ed bo
phdn. Ddu Hdn Id ehung la edm lh£ty sy thay ddi
Clio CO t h i nhu thd nhanh, tim ddp mqnh, cdng
CO, run, dd md hdi... (nhi>ng cdm gIdc cOa ca
ihl) .Phdn thu hai cOa b du Id nghi v l nhChtg
dllu khiing khilp sd xdv ro (h1|u otiing cua suy
2. Xdy di/ng md hinh hdnh vl - nhdn thtic nghi). Phdn thii ba cua lo du Id d i i u bqn Idm khi

h'ong h-j ll^u rdi logn lo du
bgn b k^ng (h-ldu chiing hdnh vl).
Quy h-lnh h-j lidu d y a h-dn 3 nguydn If co
Chf ra rang b du Id mdl cdm xuc binh thudng
bdn: cdm xiie - suy ngliT - hdnh ddng cd lidn md tdt cd mql ngudi d i u phdi hdi quo. Chung to
q u a n vd tdc
cd t h i xem b du nhu mdt bdo ddng cho hi b l ^
d d n g q u a lql
nguy hilm cd t h i d i n vd xudt hifn d ddu. Thudng
ISn n h a u . Md
tht lo du Id mdt hdnh ddng gidng nhu mdl bdo
binh tri liiu lo
ddng cdnh bdo giOp bdo v$ chung la iw6c nhOng
du dua
trin
nguy hilm hotrudng
phd I
du qud miic cd t h i dnh hudng d i n cdc chuc ndng
hdnh vl - nhin
cudc sdng hdng ngdy, Idm cho ta cd cdm gidc
thuc aim bd'n
module cd't Idl:
* Tni«if B9i lifc pte die • BNQfi U N4i

Tap chi filao due s6 2 8 7 (in i • »/aoia)


khd chju vd gdy khd khdn vdl bdn thdn. Lo du
qud miic dugc xem Id nhung bdo dqng nhdm

cOa CO the. Khi chung ta cd qud nhilu bdo ddng
nhdm, sy lo Idng vugt ro khdi tdm kilm sodt, vd
dllu dd h-d ndn cd hql.
3) Phai nhlim: Id module giup thdn chu kilm
sodt lo du vd cd phuong phdp h/ \r\ ll^u cho minh
khi ed b du. Gidl thich d l thdn chu hllu thyc
hdnh Hip xuc Id cdch thdn chO chdp nhdn h-dl
nghidm vdi nhung Hnh hudng gdy sg. Cdc Hnh
hudng gdy sg ndy se tdng theo ifidl glon khi than
chu quen ddn vdl thye hanh.
Nguyen li cGa

thye hdnh phoi

NBWftitf

nhilm: ban ddu
khi Hd'p xuc vdi
nhung kfch thich
gdy sg hdi b \6ng
sd tdng, sou mdt
ihdl gian b ldng s3
SUSi
gidm ddn mdl
cdch ly nhidn theo nguydn li cua nd. Qua dd ihdn
chii se hllu dugc Hnh hudng b sg khdng ihyc sy
nguy hilm. N l u d ^ mdt vdi Hnh hudng sg hdi thi
cdm xuc khd chju sd gidm, bdn ihdn minh ed i h l
vugt quo dugc sg hai. Tliyc hdnh lidn h ^ sy khd chju
sd gidm ddn vd minh se cdm t h ^ thodi nf>dl hon.

Bdi rfiyc hdnh f^oi nhiim cd hai f^in: fA)o\
nhilm vdl chinh nhung finh hudng thdt cOo thdn
ehu vd f^iol nhilm hjdng tugng. Ddi vdl nhDng
Hnh hudng thgt dugc Hen hdnh lidn tyc d l than
ehu CO t h i b m quen va giam ddn miic do sg hol.
Cdn bai tap thyc hanh hjdng Krqng b bdi tap
phoi nhilm ddi vdl Hnh hudng gdy sg vd chd'p
nhan quen ddn.
4} Tdi cdo trOc nhin ihuc. Tdi cdu hvc nhdn
thiic b mdt kr thudt quon trqng h-ong hj lidu hdnh
vi - nhdn thiic vdi myc dich thay ddi nhDng suy
nghT vd nllm tin khdng hqp If d l giup thdn ehii
cd t h i dllu ehlnh cdm x6c, gidi quylt vd duong
ddu vdi nhDng v^n d l ihudng gdp h-ong cude
sdng. Myc Hdu chfnh cua kr thudt tdi cdu true nhdn
thiic Id thay ddi nhDng nllm Hn cdt loi dugc hinh
thanh thdng qua nhung h-dl nghidm h> nhd vd nd
djnh hinh cdch thdn chu diSn gidl sy vide. NhDng
nllm Hn cdt Idl khdng phdi cdi md to thdy hdng
ngdy md nd b so cdu nhqn thiic md ta tin rdng
nd dung. Suy nghlchfnh b'sy phdn dnh cua nllm
Hn. Khi ddi mdl vdl nhung finh hudng khdc nhau
sd sdn sinh ra nhOng y hrdng khdc nhau.

Tap chi Blao due so 2 8 7 (ii* i • g/aoiai

3. Trdn day id md hinh hdnh vl - nhdn thue
md ehung tdi x ^ dyng d l h-j ll^u cho h-d ed rdi
loqn lo du. Vdl nriDng & thudt trdn, chung tdi tgm
thdi duo cdu true chuong h-lnh h) ll^u gdm 10

budi, kdo ddi hi 6-7 hjdn, mdl budi khodng 6070 phut. Trong mdl budi hd chi Idm vl$c ridng
vdi nhd h-j ll^u. Bdt ddu hi budi 2, budi ndo cung
ddnh hi 5 d i n 10 phut d l hdi v l nhDng dllu thdn
eho mudn ndi hdm nay. Sou dd cCing thdn ehO
duo ra Ijch b m v l ^ eua budi hdm nay: myc Hdu
la gi, phdn Heh myc Hdu ndo cdn Idm trude.
Buil 1: Xdy dt/ng mil quan hi, tim hiiu nhOng
thdng tin vi thdn chu, li do vi sao thdn ehO din
vdl trj lidu, ndi rd nguydn tdc ldm v l ^ eOng nhu
nhDng dllu cdn Idm khi thorn gia h-j ll^u, dy bdo
dugc Hin hinh vd thdi gian cuo budi h-j. E)ay Id
budi ndm bdt bon ddu v l danh sdeh vdn d l h-d
g^p phdi vd cd chdn dodn so bd v l vdn d l ciia
thdn chu. Trong budi Idm v l ^ ndy, dung kr thudt
phdng vdn ddng co d l thue ddy mong mudn hj
ll#u Clio thdn chu.
Buil 2: Truyin dgt nhung ^ nghlvi lo du, giup
thdn chu hiiu nhu thi ndo Id lo du, ddu hidu ndo
cho ta biet khi bdn thdn ta lo du, cdi gl gdy ro vd
duylrl b d u . Thdn chu hieu ro nhung gl minh cdn
Idm vd Cling cd thdm niem Hn cua than chu hong
h-j lidu.
Buil 3: Xem xdt nhung gl thdn chu da h i p thu
duqc thong qua bdi lap v l nha, nhDng khd khdn
vd nhDng n5 lyc cua thdn chO. Giup than chii hllu
nhung fch \g\ vd khdng fch Igi cOa lo du. N l u lo
du qud mDc dfin din vd'n d l bdo ddng nhdm, sii
dyng nhDng vi dy minh hqa nhu bdo chuong bdo
c^dy, hinh vd minh hga, d l quo dd thdn chO hllu
nhu t h i ndo \d bdo ddng nhdm, i h l ndo b bdo

ddng that. Quo dd dan ddi d i n v l ^ ldm the nao
d l cd thi kilm sodt vd phan bl$l duqc bdo ddng
nhdm bdo ddng thdt.
Sou hol budi ndy thdn chii cd bilt \6c ndo thi
con lo du d i n , vdl nhDng tinh hudng ndo ihl b du
cd i h l xdy ra, nhDng hdnh dqng, suy nghT, edm
xuc ndo diln ra luc dd vd kit ndi nd thanh tam
gidc edm xiie - suy nghT - hdnh ddng. Thdn chu
cd i h l hllu b du b binh thudng ndi chi bdt thudng
khi lo du qud miie, mudn kilm sodt lo du phdi
tdp l u y ^ phoi nhiem vd phdi duqc gidm sdt d l
cd t h i ed nhDng bdng chiing d l chdng \g\ khi b

au ba't hgp li.
Buil 4: Thang do nhl$t ki. Hinh thanh danh
sdeh dllu gdy sg cho than chO d l , ddy chinh Id


nhDng tinh hud'ng sd sii dyng trong module thyc
hdnh phoi nhilm sou nay. Gldl tnldu vdl thdn
ehu edeh do nhl^t k l cdm xuc. Ddy chinh Id mdt
cdng cy huu ich d l udc lugng cdm xuc ciio mdl
ehung to. Nd Id cdng cy edn thilt eho thdn chO
hong sudt qud hinh hj ll^u. EXro thdn chO nhl$l k l
edm xuc md nhd h'j ll|u dd chudn b|, hudng dfin
cdch sii dyng vd thyc hdnh ddi vdl nhiing Hnh
hudng ihdl dd thdn chii cd thi bilt edeh dOng nhl^t
kd cdm xuc. Thdn chii cd thi sii dyng thudn thyc
nhidt k l edm xuc vd hinh thdnh mdt thang sg hdi
theo thii h/ hi thdp d i n cao.

Buil 5,d: Thi/c hdnh phai nhlim dil vdl tinh
huing thit. COng ihdn enO ihyc hdnh nhOng Hnh
hudng phoi nhilm dya hdn thang sg hdi dd duge
ihllt l^p tCr budi hudc. Gldl thl$u v l thyc hdnh phoi
nhilm, gldl thfch d l thdn chii hllu t h i ndo b phoi
nhilm, cd hai loql hinh phoi nhiSm sd dugc dp
dyng ddi vdl h) l l ^ ndy b phoi nhilm vdl Hnh
hudng th^t va phoi nhilm hjdng hjgr>g. Trd \g\ vdi
thong b du, cung thdn chu chgn mdl Hnh hudng d l
thyc hdnh phoi nhilm. Dil vdl Idn ddu Hdn cOng
than ehu chgn Hnh hudng ed thi d l ddng thdnh
cdng, ehfnh dllu ndy tdng nllm Hn vdo khd ndng
thdnh edng eiia hi ll|u. Sau budi hj l l ^ thdn chii
cd thi Idm duqc bdi tdp v l nhd, hllu i h l ndo b
thyc hdnh phoi nhilm, chdp nhdn lo du din vdl
minh nhung minh cd thi dudi dugc b du.
Sudi 7 ; Thi/e hdnh phai nhlim tudng tugng.
Gidng nhu phoi nhilm ddi vdl Hnh hudng thdt thi
phoi nhilm hnSng tugng duqc sii dyng d l thyc
hdnh ddi vdi nhung kich thfch khdng d l thyc hl$n
trong co thi. Thdo ludn v l nhDng khd khdn khi
b m phoi nhilm m^t minh, cdch thiic gldl quylt
vd'n d l ndy. Dim ra ndi dung Idm v i ^ , cdch thiic
b m phoi nhilm hrdng tugng. Thdn chu cd t h i
ehdp nhdn duqc b du ciia minh, hllu minh phdi
b m gi khi lo du d i n .
Buil 8, 9: Tdi ciu trdc nhin thuc: G i u p thdn
chu nhdn ra duqrc nhOng suy nghT vd If, Hm bdng
chiing bdc bd nhOng suy nghi dd vd thoy i h l nd
bdng nhiing suy nghT hgp If d l d l l u ehfnh cdm

xijc vd gldl quylt cdc vdn d l cua ihdn chu. Gldl
thidu kr thudt tdi cdu fruc nhdn thiic boo gdm:
phdn bidt edm xiic vd suy nghT, kit nd'l ham gidc
cdm x6e - suy nghi - hdnh ddng, hgc v l suy
nghT lo du - suy nghT duong ddu, h/ nhO Heh eye
d l edm thdy h/ hdo vdl bdn thdn minh. Thdn
eho cd t h i phdn bidt duge nhQng suy nghT lo du
dang d i l n ra trong ddu vd sii dyng nhDng cdng

cy da dugc dgy d l cd t h i ddi phd vdi nhDng

suy nghT dd.
Buil 10: Ki hogch cho tuemg lai vd kit thOc trf
liiu. Dy bdo h-udc nhDng Hnh hudng khd khdn
md thdn chii cd t h i g^p hong hjang Igi, cOng cd
nhOng gl thdn chO da hqc vd giup thdn chO thyc
hdnh thudn thye nhDng kr ihudi ndv. Nhdc lql vdi
thdn cho nhDng kr thudt thdn chO <» dugc hgc d l
kilm sodt lo du. Nhdn mqnh tdm quon hrgng cOa
thyc hdnh, ihudng xuydn. D l thdn chO ddng vol
nhd h{ lidu cOng nhd h-j lidu gldl quylt nhDng vdn
d l trong hjong b l cd thd Idm lo du tdi phdt.
Sou khi Hin hdnh sdng Igc 200 HS khdi bp
10,11 h-udng THPT Marie Curie, TP Hd Chf Minh,
chung tdi chqn 2 HS ed vdn d l b du d l hi ll|u.
Sou 10 budi Idm vide b du cOo thdn chO gidm
ddn, lue bdt ddu h'j lidu dilm d thong Zung hgn
4 0 nhung sou dd gidm ddn xudng mue dilm
khdng ddp iing rdi b q n b du. Thdn chO n i ^ bdt
duqc cdch ihiic dllu chfnh khi b du d i n . Ddy b

md hinh h-j ll^u thich hgp, d l ihyc hl^n ddi vdf
HS THPT. Hon t h i nuo mang b i hl^u qud nhonh
ehdng nhd Irj ll$u d l nhdn thdy dugc nhiing thay
ddi cua thdn chO quo hing budi h^ li^u. Q

Tiki li^u tham khdo
1. Bruce F.Chorpita. Modular Q^nidve - Behavioral
Therapy for Childhood Anxiety Disorders. NXB A
Division of Guilford Publication, New York 2007.
2. Craig Winston. Le Croy. Handboolt of Evidence •
Based Treatment Manuals For children and
adolescents. NXB Oxford University press. New Y(rt
2008.
3. Paul Staltard. Think google - Feel Good. NXB John
Wiley & Sons Ud. England 2002.
4. Nguydn Khdc Vi?n.TAni It Ifim sdng trd em Vift
Nam. NXB Yhgc, H 2008.
5. D9ng Bi Ltkm - Weiss Bahr. Gido dye Idm li vd sih:
khde tdm thdn ti^ em Vift Nam. NXB B^i hoc qu/Sc
gia Hd N0i, H 2007.
SUMMARY

The article buikis up a model of arvdety disorder
therapy txised on tjetxTt/kx-cogr^tion sct>ool ^ydudIngfyur core modules l) Scale of fear. 2) Learn ctxut
anxiety. 3) Exposure. 4) Cognitive restnjcturlng. With
the above techniques, the ojttior temporarity puts
the cognitive tsetKTtdor thereby program s^ucture of
10 sessions OncSviduci cNkJ only worits wWh therapist)
lasting from 6-7 weeks, atxxjt 60-70 minute each session. VTercf>y process based on three bos/c principles:
emotlons-think-act. This Is an appropriate therapy

model, v^lch is easy to implement for Uf^persecondary sctioot students.

Tap chifilaodue so 2 8 7 (id i • «/aoiai