知行分析疗法治疗抑郁症的效果研究
|
摘要
背景抑郁症患者常因强烈的病耻感、较低的治疗依从性导致疾病得不到有效控制,甚至加重抑郁的症状,因此,在治疗抑郁症的同时需开展降低患者病耻感、提高治疗依从性的心理治疗。目的观察知行分析疗法(PBAT)对抑郁症(MDD)患者的治疗依从性、病耻感以及抑郁症状的影响。方法选择2017年1月—2018年1月于扬州大学附属苏北人民医院临床心理科门诊治疗的MDD患者75例为研究对象。采用随机数字表法将患者分为研究组38例和对照组37例。两组患者均给予选择性5-羟色胺再摄取抑制剂(SSRIs)西酞普兰治疗,此外,对照组予常规心理健康教育,研究组给予PBAT(根据治疗设置,共需8次,50 min/次)。收集患者一般资料,分别于治疗前及治疗后(治疗8周时)采用Morisky治疗依从性问卷(MMAS-8)评估患者治疗依从性,病耻感自我评估量表(SS)评估患者的病耻感,汉密尔顿抑郁量表(HAMD)-24评估患者抑郁症状及治疗效果。结果研究组治疗后MMAS-8得分高于对照组(P<0.05);研究组治疗后MMAS-8得分高于治疗前(P<0.05)。研究组治疗后治疗依从性优于对照组(P<0.05);对照组、研究组治疗后治疗依从性均优于本组治疗前(P<0.05)。研究组治疗后社交、能力、治疗维度得分及SS总分低于对照组(P<0.05);研究组治疗后社交、能力、治疗维度得分及SS总分低于治疗前(P<0.05)。研究组治疗后HAMD-24得分低于对照组(P<0.05);对照组、研究组治疗后HMAD-24得分均低于本组治疗前(P<0.05)。研究组治疗效果优于对照组(P<0.05)。结论 PBAT可有效增加MDD患者的治疗依从性,降低其病耻感,减少抑郁症状,提升治疗效果。
Background Major depressive disorder(MDD)patients often suffer from severe stigma and low treatment compliance,which leads to the failure of effective control of the disease and even aggravates the symptoms of depression.Psychotherapy should be carried out to reduce the stigma of patients and improve treatment compliance while treating depression.Objective To observe the effects of perceptional and behavioral analysis therapy(PBAT)on the treatment compliance,stigma and depressive symptoms in patients with MDD.Methods Seventy-five MDD outpatients were selected from Department of Clinical Psychology,Subei People's Hospital Affiliated to Yangzhou University from January 2017 to January 2018.They were divided into study group(38 cases)and control group(37 cases)by use of a random number table method,receiving personalized 50-minute PBAT(totaled 8 times,performed according to the treatment regimen),conventional psychological education,respectively,on the basis of treatment with citalopram(an antidepressant drug belonging to the selective 5-serotonin reuptake inhibitors).Basic demographic characteristics were collected.Treatment adherence,stigma,and depressive symptoms were assessed by the 8-item Morisky Medication Adherence Scale(MMAS-8),Scale of Stigma(SS),24-item Hamilton Depression Scale(HAMD-24),respectively,at baseline and the end of 8-week treatment.Treatment effect was evaluated by the HAMD-24 when the 8-week treatment ended.Results The scores of MMAS-8 were much higher in the studygroup than those of the control group(P<0.05).The scores of MMAS-8 were higher in the study group after treatment than before treatment(P<0.05).The treatment compliance after treatment of the study group was better than that of the control group(P<0.05).The treatment compliance improved significantly in both groups(P<0.05).After treatment,the scores of SS and its 3 dimensions(sociality,ability and therapeutic dimensions)decreased significantly in the study group compared with baseline(P<0.05),and they were much lower in the study group compared with those of the control group(P<0.05).After treatment,the scores of HAMD-24 decreased significantly in both groups compared with baseline(P<0.05),and they were much lower in the study group compared with those of the control group(P<0.05).The treatment effect of the study group was better than that of the control group(P<0.05).Conclusion PBAT can effectively increase the treatment compliance of MDD patients,relieve the depressive symptoms and improve the treatment effects.
Background Major depressive disorder(MDD)patients often suffer from severe stigma and low treatment compliance,which leads to the failure of effective control of the disease and even aggravates the symptoms of depression.Psychotherapy should be carried out to reduce the stigma of patients and improve treatment compliance while treating depression.Objective To observe the effects of perceptional and behavioral analysis therapy(PBAT)on the treatment compliance,stigma and depressive symptoms in patients with MDD.Methods Seventy-five MDD outpatients were selected from Department of Clinical Psychology,Subei People's Hospital Affiliated to Yangzhou University from January 2017 to January 2018.They were divided into study group(38 cases)and control group(37 cases)by use of a random number table method,receiving personalized 50-minute PBAT(totaled 8 times,performed according to the treatment regimen),conventional psychological education,respectively,on the basis of treatment with citalopram(an antidepressant drug belonging to the selective 5-serotonin reuptake inhibitors).Basic demographic characteristics were collected.Treatment adherence,stigma,and depressive symptoms were assessed by the 8-item Morisky Medication Adherence Scale(MMAS-8),Scale of Stigma(SS),24-item Hamilton Depression Scale(HAMD-24),respectively,at baseline and the end of 8-week treatment.Treatment effect was evaluated by the HAMD-24 when the 8-week treatment ended.Results The scores of MMAS-8 were much higher in the studygroup than those of the control group(P<0.05).The scores of MMAS-8 were higher in the study group after treatment than before treatment(P<0.05).The treatment compliance after treatment of the study group was better than that of the control group(P<0.05).The treatment compliance improved significantly in both groups(P<0.05).After treatment,the scores of SS and its 3 dimensions(sociality,ability and therapeutic dimensions)decreased significantly in the study group compared with baseline(P<0.05),and they were much lower in the study group compared with those of the control group(P<0.05).After treatment,the scores of HAMD-24 decreased significantly in both groups compared with baseline(P<0.05),and they were much lower in the study group compared with those of the control group(P<0.05).The treatment effect of the study group was better than that of the control group(P<0.05).Conclusion PBAT can effectively increase the treatment compliance of MDD patients,relieve the depressive symptoms and improve the treatment effects.
引文
[1]CHANG C C,TZENG N S,KAO Y C,et al.The relationships of current suicidal ideation with inflammatory markers and heart rate variability in unmedicated patients with major depressive disorder[J].Psychiatry Res,2017,258:449-456.DOI:10.1016/j.psychres.2017.08.076.
[2]ZHANG K,ZHU Y,ZHU Y,et al.Molecular,functional,and structural imaging of major depressive disorder[J].Neurosci Bull,2016,32(3):273-285.DOI:10.1007/s12264-016-0030-0.
[3]LAU Y W,PICCO L,PANG S,et al.Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients[J].Psychiatry Res,2017,257:72-78.DOI:10.1016/j.psychres.2017.07.027.
[4]LATALOVA K,KAMARADOVA D,PRASKO J.Perspectives on perceived stigma and self-stigma in adult male patients with depression[J].Neuropsychiatr Dis Treat,2014,10:1399-1405.DOI:10.2147/ndt.s54081.
[5]TUCKER J R,HAMMER J H,VOGEL D L,et al.Disentangling self-stigma:are mental illness and help-seeking self-stigmas different?[J].J Couns Psychol,2013,60(4):520-531.DOI:10.1037/a0033555.
[6]CARRARA B S,VENTURA C A A.Self-stigma,mentally ill persons and health services:an integrative review of literature[J].Arch Psychiatr Nurs,2018,32(2):317-324.DOI:10.1016/j.apnu.2017.11.001.
[7]WENZLER S,HAGEN M,TARVAINEN M P,et al.Intensified emotion perception in depression:differences in physiological arousal and subjective perceptions[J].Psychiatry Res,2017,253:303-310.DOI:10.1016/j.psychres.2017.03.040.
[8]GUERRA C,FARKAS C,MONCADA L.Depression,anxiety and PTSD in sexually abused adolescents:association with selfefficacy,coping and family support[J].Child Abuse Negl,2017,76:310-320.DOI:10.1016/j.chiabu.2017.11.013.
[9]HOFMANN S G,GóMEZ A F.Mindfulness-based interventions for anxiety and depression[J].Psychiatr Clin North Am,2017,40(4):739-749.DOI:10.1016/j.psc.2017.08.008.
[10]LINKS P S,SHAH R,EYNAN R.Psychotherapy for borderline personality disorder:progress and remaining challenges[J].Curr Psychiatry Rep,2017,19(3):16.DOI:10.1007/s11920-017-0766-x.
[11]美国精神医学学会.精神障碍诊断与统计手册[M].张道龙,译.5版.北京:北京大学出版社,2015:154-161.
[12]张明园.精神科评定量表手册[M].2版.长沙:湖南科学技术出版社,1998:35-39.
[13]江开达,马弘.中国精神疾病防治指南:实用版[M].北京:北京大学医学出版社,2010:72-77.
[14]WANG Y,KONG M C,KO Y.Psychometric properties of the 8-item Morisky Medication Adherence Scale in patients taking warfarin[J].Thromb Haemost,2012,108(4):789-795.DOI:10.1160/th12-05-0368.
[15]XUM,MARKSTR?MU,LYUJ,etal.Detectionoflow adherence in rural tuberculosis patients in China:application of Morisky Medication Adherence Scale[J].Int J Environ ResPublicHealth,2017, 14(3):E248.DOI:10.3390/ijerph14030248.
[16]YANG A,WANG B,ZHU G,et al.Validation of Chinese version of the Morisky medication adherence scale in patients with epilepsy[J].Seizure,2014,23(4):295-299.DOI:10.1016/j.seizure.2014.01.003.
[17]曾庆枝,何燕玲,田泓,等.精神病患者病耻感评估量表的初步编制[J].中国心理卫生杂志,2009,23(9):634-637.DOI:10.3969/j.issn.1000-6729.2009.09.007.ZENG Q Z,HE Y L,TIAN H,et al.Development of scale of stigma in people with mental illness[J].Chinese Mental Health Journal,2009,23(9):634-637.DOI:10.3969/j.issn.1000-6729.2009.09.007.
[18]CORRIGAN P.How stigma interferes with mental health care[J].Am Psychol,2004,59(7):614-625.DOI:10.1037/0003-066x.59.7.614.
[19]MIDGLEY N,PARKINSON S,HOLMES J,et al."Did I bring it on myself?"An exploratory study of the beliefs that adolescents referred to mental health services have about the causes of their depression[J].Eur Child Adolesc Psychiatry,2017,26(1):25-34.DOI:10.1007/s00787-016-0868-8.
[20]周莉华,康林,陈娅薇.老年冠心病合并抑郁症患者综合治疗效果观察[J].疑难病杂志,2012,11(7):537-538.DOI:10.3969/j.issn.1671-6450.2012.07.018.ZHOU L H,KANG L,CHEN Y W.Observation on the effect of comprehensive treatment for senile patients with coronary heart disease and depression[J].Chinese Journal of Difficult and Complicated Cases,2012,11(7):537-538.DOI:10.3969/j.issn.1671-6450.2012.07.018.
[21]汤芙蓉,闻永.大学生心理疾病污名和心理求助态度的关系[J].中国健康心理学杂志,2015,23(10):1495-1499.DOI:10.13342/j.cnki.cjhp.2015.10.016.TANG F R,WEN Y.The Relationship between psychological illness stigma and psychological help attitude[J].China Journal of Health Psychology,2015,23(10):1495-1499.DOI:10.13342/j.cnki.cjhp.2015.10.016.
[22]林慧,梁祖光,梁飘,等.重性精神病患者及其家属病耻感调查与干预[J].中国全科医学,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.LIN H,LIANG Z G,LIANG P,et al.Severe mental illness stigma investigation and intervention[J].Chinese General Practice,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.
[23]MARTINEZLR,XUS,HEBLM.Utilizingeducation andperspectivetakingtoremediatethestigmaoftaking antidepressants[J].Community Ment Health J,2018,54(4):450-459.DOI:10.1007/s10597-017-0174-z.
[24]BILGE A,PALABIYIK O.The effect of short films about mental health and disorders on preventing stigmatization in nursing education[J].Arch Psychiatr Nurs,2017,31(1):88-92.DOI:10.1016/j.apnu.2016.09.006.
[25]KENDRA M S,MOHR J J,POLLARD J W.The stigma of having psychological problems:relations with engagement,working alliance,and depression in psychotherapy[J].Psychotherapy(Chic),2014,51(4):563-573.DOI:10.1037/a0036586.
[26]CAMERON S K,RODGERS J,DAGNAN D.The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression:a meta-analytic review[J].Clin Psychol Psychother,2018,25(3):446-456.DOI:10.1002/cpp.2180.
[27]RYBA M M,LEJUEZ C W,HOPKO D R.Behavioral activation for depressed breast cancer patients:the impact of therapeutic compliance and quantity of activities completed on symptom reduction[J].J Consult Clin Psychol,2014,82(2):325-335.DOI:10.1037/a0035363.
[28]JOHNCO C,RAPEE R M.Depression literacy and stigma influence how parents perceive and respond to adolescent depressive symptoms[J].J Affect Disord,2018,241:599-607.DOI:10.1016/j.jad.2018.08.062.
[29]李江婵,姚素华,谢秀东,等.认知行为治疗对抑郁症患者病耻感和应对方式的影响研究[J].中国全科医学,2015,18(4):463-465.DOI:10.3969/j.issn.1007-9572.2015.04.027.LI J C,YAO S H,XIE X D,et al.Influences of cognitive behavioral therapy in stigma and coping styles of depression patients[J].Chinese General Practice,2015,18(4):463-465.DOI:10.3969/j.issn.1007-9572.2015.04.027.
[2]ZHANG K,ZHU Y,ZHU Y,et al.Molecular,functional,and structural imaging of major depressive disorder[J].Neurosci Bull,2016,32(3):273-285.DOI:10.1007/s12264-016-0030-0.
[3]LAU Y W,PICCO L,PANG S,et al.Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients[J].Psychiatry Res,2017,257:72-78.DOI:10.1016/j.psychres.2017.07.027.
[4]LATALOVA K,KAMARADOVA D,PRASKO J.Perspectives on perceived stigma and self-stigma in adult male patients with depression[J].Neuropsychiatr Dis Treat,2014,10:1399-1405.DOI:10.2147/ndt.s54081.
[5]TUCKER J R,HAMMER J H,VOGEL D L,et al.Disentangling self-stigma:are mental illness and help-seeking self-stigmas different?[J].J Couns Psychol,2013,60(4):520-531.DOI:10.1037/a0033555.
[6]CARRARA B S,VENTURA C A A.Self-stigma,mentally ill persons and health services:an integrative review of literature[J].Arch Psychiatr Nurs,2018,32(2):317-324.DOI:10.1016/j.apnu.2017.11.001.
[7]WENZLER S,HAGEN M,TARVAINEN M P,et al.Intensified emotion perception in depression:differences in physiological arousal and subjective perceptions[J].Psychiatry Res,2017,253:303-310.DOI:10.1016/j.psychres.2017.03.040.
[8]GUERRA C,FARKAS C,MONCADA L.Depression,anxiety and PTSD in sexually abused adolescents:association with selfefficacy,coping and family support[J].Child Abuse Negl,2017,76:310-320.DOI:10.1016/j.chiabu.2017.11.013.
[9]HOFMANN S G,GóMEZ A F.Mindfulness-based interventions for anxiety and depression[J].Psychiatr Clin North Am,2017,40(4):739-749.DOI:10.1016/j.psc.2017.08.008.
[10]LINKS P S,SHAH R,EYNAN R.Psychotherapy for borderline personality disorder:progress and remaining challenges[J].Curr Psychiatry Rep,2017,19(3):16.DOI:10.1007/s11920-017-0766-x.
[11]美国精神医学学会.精神障碍诊断与统计手册[M].张道龙,译.5版.北京:北京大学出版社,2015:154-161.
[12]张明园.精神科评定量表手册[M].2版.长沙:湖南科学技术出版社,1998:35-39.
[13]江开达,马弘.中国精神疾病防治指南:实用版[M].北京:北京大学医学出版社,2010:72-77.
[14]WANG Y,KONG M C,KO Y.Psychometric properties of the 8-item Morisky Medication Adherence Scale in patients taking warfarin[J].Thromb Haemost,2012,108(4):789-795.DOI:10.1160/th12-05-0368.
[15]XUM,MARKSTR?MU,LYUJ,etal.Detectionoflow adherence in rural tuberculosis patients in China:application of Morisky Medication Adherence Scale[J].Int J Environ ResPublicHealth,2017, 14(3):E248.DOI:10.3390/ijerph14030248.
[16]YANG A,WANG B,ZHU G,et al.Validation of Chinese version of the Morisky medication adherence scale in patients with epilepsy[J].Seizure,2014,23(4):295-299.DOI:10.1016/j.seizure.2014.01.003.
[17]曾庆枝,何燕玲,田泓,等.精神病患者病耻感评估量表的初步编制[J].中国心理卫生杂志,2009,23(9):634-637.DOI:10.3969/j.issn.1000-6729.2009.09.007.ZENG Q Z,HE Y L,TIAN H,et al.Development of scale of stigma in people with mental illness[J].Chinese Mental Health Journal,2009,23(9):634-637.DOI:10.3969/j.issn.1000-6729.2009.09.007.
[18]CORRIGAN P.How stigma interferes with mental health care[J].Am Psychol,2004,59(7):614-625.DOI:10.1037/0003-066x.59.7.614.
[19]MIDGLEY N,PARKINSON S,HOLMES J,et al."Did I bring it on myself?"An exploratory study of the beliefs that adolescents referred to mental health services have about the causes of their depression[J].Eur Child Adolesc Psychiatry,2017,26(1):25-34.DOI:10.1007/s00787-016-0868-8.
[20]周莉华,康林,陈娅薇.老年冠心病合并抑郁症患者综合治疗效果观察[J].疑难病杂志,2012,11(7):537-538.DOI:10.3969/j.issn.1671-6450.2012.07.018.ZHOU L H,KANG L,CHEN Y W.Observation on the effect of comprehensive treatment for senile patients with coronary heart disease and depression[J].Chinese Journal of Difficult and Complicated Cases,2012,11(7):537-538.DOI:10.3969/j.issn.1671-6450.2012.07.018.
[21]汤芙蓉,闻永.大学生心理疾病污名和心理求助态度的关系[J].中国健康心理学杂志,2015,23(10):1495-1499.DOI:10.13342/j.cnki.cjhp.2015.10.016.TANG F R,WEN Y.The Relationship between psychological illness stigma and psychological help attitude[J].China Journal of Health Psychology,2015,23(10):1495-1499.DOI:10.13342/j.cnki.cjhp.2015.10.016.
[22]林慧,梁祖光,梁飘,等.重性精神病患者及其家属病耻感调查与干预[J].中国全科医学,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.LIN H,LIANG Z G,LIANG P,et al.Severe mental illness stigma investigation and intervention[J].Chinese General Practice,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.
[23]MARTINEZLR,XUS,HEBLM.Utilizingeducation andperspectivetakingtoremediatethestigmaoftaking antidepressants[J].Community Ment Health J,2018,54(4):450-459.DOI:10.1007/s10597-017-0174-z.
[24]BILGE A,PALABIYIK O.The effect of short films about mental health and disorders on preventing stigmatization in nursing education[J].Arch Psychiatr Nurs,2017,31(1):88-92.DOI:10.1016/j.apnu.2016.09.006.
[25]KENDRA M S,MOHR J J,POLLARD J W.The stigma of having psychological problems:relations with engagement,working alliance,and depression in psychotherapy[J].Psychotherapy(Chic),2014,51(4):563-573.DOI:10.1037/a0036586.
[26]CAMERON S K,RODGERS J,DAGNAN D.The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression:a meta-analytic review[J].Clin Psychol Psychother,2018,25(3):446-456.DOI:10.1002/cpp.2180.
[27]RYBA M M,LEJUEZ C W,HOPKO D R.Behavioral activation for depressed breast cancer patients:the impact of therapeutic compliance and quantity of activities completed on symptom reduction[J].J Consult Clin Psychol,2014,82(2):325-335.DOI:10.1037/a0035363.
[28]JOHNCO C,RAPEE R M.Depression literacy and stigma influence how parents perceive and respond to adolescent depressive symptoms[J].J Affect Disord,2018,241:599-607.DOI:10.1016/j.jad.2018.08.062.
[29]李江婵,姚素华,谢秀东,等.认知行为治疗对抑郁症患者病耻感和应对方式的影响研究[J].中国全科医学,2015,18(4):463-465.DOI:10.3969/j.issn.1007-9572.2015.04.027.LI J C,YAO S H,XIE X D,et al.Influences of cognitive behavioral therapy in stigma and coping styles of depression patients[J].Chinese General Practice,2015,18(4):463-465.DOI:10.3969/j.issn.1007-9572.2015.04.027.