CBT 프로토콜 구현

3.1 Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy represents a "third wave" behavioral therapy that uses acceptance and mindfulness strategies alongside commitment and behavior change strategies to increase psychological flexibility. Rather than trying to eliminate unwanted thoughts and feelings, ACT teaches people to accept them while committing to value-driven actions.

The Six Core ACT Processes

ACT is built on six interconnected processes that work together to enhance psychological flexibility - the ability to be present, open up to experience, and do what matters.

Digital ACT Module Implementation

interface ACTModule {
  // Core ACT processes
  processes: {
    defusion: DefusionExercise[];
    acceptance: AcceptanceExercise[];
    presentMoment: MindfulnessExercise[];
    selfAsContext: PerspectiveTakingExercise[];
    values: ValuesExercise[];
    committedAction: ActionPlanningExercise[];
  };
  
  // Values assessment
  valuesAssessment: {
    domains: ValuesDomain[];
    rankingExercise: InteractiveRanking;
    alignment: ValuesAlignmentCheck;
  };
  
  // Metaphor library
  metaphors: TherapeuticMetaphor[];
  
  // Commitment tracking
  commitmentTracker: {
    goals: ACTGoal[];
    barriers: IdentifiedBarrier[];
    progress: ActionProgress[];
  };
}

interface ValuesExercise {
  type: 'clarification' | 'exploration' | 'alignment';
  
  domains: {
    family: ValuesStatement[];
    relationships: ValuesStatement[];
    work: ValuesStatement[];
    education: ValuesStatement[];
    health: ValuesStatement[];
    leisure: ValuesStatement[];
    spirituality: ValuesStatement[];
    community: ValuesStatement[];
  };
  
  // Interactive ranking
  prioritize(): Promise;
  
  // Check alignment with actions
  assessAlignment(
    values: Value[],
    actions: Action[]
  ): AlignmentScore;
}

// Example: Values Compass Exercise
class ValuesCompass {
  domains = [
    'Relationships',
    'Work/Career', 
    'Personal Growth',
    'Health/Wellbeing',
    'Leisure/Fun',
    'Spirituality',
    'Community',
    'Environment'
  ];
  
  async conductExercise(userId: string): Promise {
    // Step 1: Rate importance (0-10)
    const importance = await this.rateImportance(this.domains);
    
    // Step 2: Rate current alignment (0-10)
    const alignment = await this.rateAlignment(this.domains);
    
    // Step 3: Calculate discrepancy
    const discrepancies = this.domains.map((domain, i) => ({
      domain,
      importance: importance[i],
      alignment: alignment[i],
      gap: importance[i] - alignment[i]
    }));
    
    // Step 4: Identify priority areas (highest gaps)
    const priorities = discrepancies
      .filter(d => d.gap >= 3)
      .sort((a, b) => b.gap - a.gap);
    
    // Step 5: Generate action recommendations
    const actions = priorities.map(p => 
      this.generateActionIdeas(p.domain)
    );
    
    return {
      profile: discrepancies,
      priorities,
      recommendedActions: actions
    };
  }
  
  private generateActionIdeas(domain: string): string[] {
    const actionLibrary = {
      'Relationships': [
        'Schedule weekly quality time with loved ones',
        'Reach out to someone you miss',
        'Practice active listening in conversations',
        'Express appreciation to someone daily'
      ],
      'Health/Wellbeing': [
        'Establish a consistent sleep schedule',
        'Add one healthy meal per day',
        'Take a 10-minute walk daily',
        'Schedule preventive health appointments'
      ],
      // ... other domains
    };
    
    return actionLibrary[domain] || [];
  }
}

3.2 Interpersonal Therapy (IPT)

Interpersonal Therapy is a time-limited, diagnosis-focused therapy that addresses the relationship between mood symptoms and interpersonal functioning. IPT focuses on four problem areas: grief and loss, role transitions, interpersonal disputes, and interpersonal deficits.

IPT Problem Areas and Interventions

Relationship Mapping Tool

One of the most powerful digital IPT tools is interactive relationship mapping, which helps patients visualize their social network, identify support sources and conflict areas, and track changes over time.

interface IPTModule {
  // Identify primary problem area
  problemAreaAssessment: {
    grief: GriefAssessment;
    roleTransition: RoleTransitionAssessment;
    interpersonalDispute: DisputeAssessment;
    interpersonalDeficit: DeficitAssessment;
  };
  
  // Relationship inventory
  relationshipInventory: {
    significantRelationships: Relationship[];
    supportSources: SupportNetwork;
    conflictAreas: ConflictAnalysis[];
  };
  
  // Communication skills
  communicationTraining: {
    expressionExercises: CommunicationExercise[];
    activeListening: ListeningPractice[];
    conflictResolution: ConflictSkills[];
  };
  
  // Social rhythm tracking
  socialRhythm: {
    dailyRoutine: RoutineTracker;
    socialContacts: ContactLog;
    regularityScore: number;
  };
}

// Social Rhythm Metric Tracking
interface SocialRhythmTracker {
  activities: {
    name: string;
    timeOfDay: Time;
    people: string[]; // who was present
    consistency: number; // 1-5 scale
  }[];
  
  regularityIndex: number; // overall stability
  
  trackActivity(
    activity: string,
    time: Time,
    socialContext: string[]
  ): void;
  
  calculateRegularity(): number;
  
  identifyDisruptions(): Disruption[];
}

3.3 Mindfulness-Based Cognitive Therapy (MBCT)

MBCT integrates mindfulness meditation practices with cognitive therapy techniques, specifically developed to prevent relapse in recurrent depression. The program teaches participants to recognize and disengage from habitual negative thought patterns that trigger depressive episodes.

The 8-Week MBCT Program

Guided Meditation Library

A comprehensive digital MBCT implementation requires an extensive library of guided audio meditations with varying lengths and focuses to support daily practice and accommodate different schedules.

interface MBCTMeditationLibrary {
  bodyScan: {
    duration: '10min' | '20min' | '45min';
    narrator: string;
    audio: AudioFile;
    transcript: string;
  }[];
  
  sittingMeditation: {
    focus: 'breath' | 'body' | 'sounds' | 'thoughts' | 'open-awareness';
    duration: '5min' | '10min' | '20min' | '30min';
    guidanceLevel: 'full' | 'moderate' | 'minimal';
    audio: AudioFile;
  }[];
  
  breathingSpace: {
    variant: 'standard' | 'extended' | 'emergency';
    duration: '3min' | '5min' | '10min';
    audio: AudioFile;
  }[];
  
  mindfulMovement: {
    type: 'gentle-yoga' | 'stretching' | 'walking';
    duration: '10min' | '20min' | '30min';
    video: VideoFile;
    modifications: Modification[];
  }[];
  
  // Practice tracking
  practiceLog: {
    date: Date;
    practice: string;
    duration: number;
    experience: string;
    difficulty: number; // 1-10
    insights: string;
  }[];
  
  // Mindfulness bell reminders
  bells: {
    frequency: 'hourly' | '2hours' | '3hours' | 'custom';
    startTime: Time;
    endTime: Time;
    sound: AudioFile;
    prompt: string;
  };
}

3.4 Advanced Progress Tracking

With multiple therapy modalities, comprehensive progress tracking becomes essential to understand which approaches work best for which patients under what circumstances.

Multi-Dimensional Progress Metrics

3.5 Therapist Collaboration Portal

While digital therapeutics can function autonomously, integration with human clinicians significantly enhances outcomes, especially for more severe cases. The therapist portal provides comprehensive patient oversight while respecting boundaries of digital-first treatment.

Portal Features

interface TherapistPortal {
  // Patient dashboard
  patients: {
    overview: PatientOverview[];
    alerts: ClinicalAlert[];
    pending: ActionItem[];
  };
  
  // Individual patient view
  patientDetail: {
    demographics: BasicInfo;
    diagnosisInfo: DiagnosisData;
    currentTreatment: TreatmentPlan;
    progressCharts: ProgressVisualization[];
    recentSessions: SessionSummary[];
    assessmentHistory: Assessment[];
    safetyFlags: SafetyAlert[];
  };
  
  // Clinical documentation
  documentation: {
    createNote(type: 'SOAP' | 'progress' | 'discharge'): Note;
    updateTreatmentPlan(patientId: string, plan: TreatmentPlan): void;
    signDocumentation(noteId: string): void;
  };
  
  // Communication
  messaging: {
    sendMessage(patientId: string, content: string): void;
    viewMessages(patientId: string): Message[];
    setAutoResponder(config: AutoResponderConfig): void;
  };
  
  // Analytics and reporting
  analytics: {
    caseload: CaseloadStats;
    outcomes: OutcomeMetrics;
    engagement: EngagementMetrics;
    qualityIndicators: QualityMetrics;
  };
}