沙盘疗法对女性暴食症及非典型性暴食症患者的疗效研究
摘要
本研究的目的是探索沙盘疗法对女性暴食症及非典型性暴食症患者的治疗效果,研究包括两个个体沙盘治疗案例和一个团体沙盘治疗案例,其中团体沙盘治疗中包括4个成员,个体沙盘治疗和团体沙盘治疗各有6次。本研究采用进食态度测验(EAT-26)筛选出可能患有进食障碍的个体,进一步采用进食障碍检查表(EDE,16.0)和临床损伤评估问卷(CIA)对筛选出的可能患有进食障碍的个体进行临床诊断与评估,最后,得到2名女性暴食症患者和4名女性非典型性暴食症患者。2名非典型性暴食症患者参与个体沙盘治疗,剩余4名患者参与团体沙盘治疗。
通过比较患者治疗前后EDE、CIA得分以及各症状指标的变化,结果发现,3名患者(包括1名暴食症患者和2名非典型性暴食症患者)的暴食频率有显著下降,其中暴食症患者的催吐频率也有显著下降；其他3名患者的暴食频率无显著降低,但是,这3名患者中的暴食症患者的催吐频率有所下降,1名非典型性暴食症患者的过度运动频率也有所下降。此外,沙盘治疗之后的访谈以及被试的自我感想中发现,6名被试在对自我的认知、应对方式和与人交往方式的认知都有所改善。
本研究的结果表明沙盘疗法对治疗女性暴食症及非典型暴食症是一种有效的治疗模式。
The present study aimed to explore the effect of the sandplay therapy on female bulimia and under-bulimia, including two individual case and one four-member group case. The sandplay of each form consists of 6 sessions. At first, the Eating Attidude Test (EAT) was used to screen out individuals who might have an eating disorder. The following step was to make clinical assessment and diagnose of the individuals. In the end, six females, of whom two were bulimia and the rest four were under-bulimia, took part in the therapy. Two under-bulimia females accepted individual sandplay therapy, while the other four joined in group sandplay.
The result from comparison of the score on EDE and CIA before and after the sandplay came out that the binge frequency of three women, one bulimia and two under-bulimia, declined and the purge frequency of the bulimia was decreased, too. On the contrast, the symptom of the rest didn't change significantly except that the purge frequency of the bulimia one was reduced and that one under-bulimia patient's frequence of excessive exercise dropped.
The present study indicated that the sandplay was an effective therapy on famale bulimia and under-bulimia.
通过比较患者治疗前后EDE、CIA得分以及各症状指标的变化,结果发现,3名患者(包括1名暴食症患者和2名非典型性暴食症患者)的暴食频率有显著下降,其中暴食症患者的催吐频率也有显著下降；其他3名患者的暴食频率无显著降低,但是,这3名患者中的暴食症患者的催吐频率有所下降,1名非典型性暴食症患者的过度运动频率也有所下降。此外,沙盘治疗之后的访谈以及被试的自我感想中发现,6名被试在对自我的认知、应对方式和与人交往方式的认知都有所改善。
本研究的结果表明沙盘疗法对治疗女性暴食症及非典型暴食症是一种有效的治疗模式。
The present study aimed to explore the effect of the sandplay therapy on female bulimia and under-bulimia, including two individual case and one four-member group case. The sandplay of each form consists of 6 sessions. At first, the Eating Attidude Test (EAT) was used to screen out individuals who might have an eating disorder. The following step was to make clinical assessment and diagnose of the individuals. In the end, six females, of whom two were bulimia and the rest four were under-bulimia, took part in the therapy. Two under-bulimia females accepted individual sandplay therapy, while the other four joined in group sandplay.
The result from comparison of the score on EDE and CIA before and after the sandplay came out that the binge frequency of three women, one bulimia and two under-bulimia, declined and the purge frequency of the bulimia was decreased, too. On the contrast, the symptom of the rest didn't change significantly except that the purge frequency of the bulimia one was reduced and that one under-bulimia patient's frequence of excessive exercise dropped.
The present study indicated that the sandplay was an effective therapy on famale bulimia and under-bulimia.
引文
1. Bohn, K., Doll, H. A., Cooper, Z., O'Connor, M.E., Palmer, R.L.,&Fairburn, C. G. The measurement of impairment due to eating disorder psychopathology[J]. Behaviour Research and Therapy.2008,46:1105-1110.
2. Bulik C M, Sullivan P F, Wade T D, et al. Twin Studies of Eating Disorders:A Review[J]. International Journal of Eating Disorder.2000.27(1):1-20.
3. Carl Jung. Archetypes and the Collective Unconscious. Princeton:Princeton University Press.1977.
4. Cognitive Behavior Therapy and Eating Disorders.Christopher G. Fairburn. New York. The Guilford Press.2008.
5. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, et al.Increased Mortality in Bulimia Nervosa and Other Eating Disorders[J]. American Journal of Psychiatry.2009.130:1342-1346.
6. Daisuke Yasuhara, Naoko Homan, Nobuatsu Nagai et al,A Significant Nationwide Increase in the Prevalence of Eating Disorders in Japan:1998-year Survey[J]. International Congress Series.2002.1241:297-301.
7. Daniel le Grange, James Lock et al. Academy for Eating Disorders Position Paper: the Role of the Family in Eating Disorders[J]. International Journal of Eating Disorders.2010.43(1):1-5.
8. Dora Kalff. Sandplay:A Psychotherapeutic Approach to the Psyche. Sigo Press, 1980.
9. Dora Kalff. Foreword. In Katherine Bradway. Sandplay Studies:Origins, Theory & Practice. Boston:Sigo Press.1990.
10. Drew A. Anderson, Kathleen C. Maloney. The Efficacy of Cognitive-behavioral Therapy on the Core Symptoms of Bulimia Nervosa[J]. Clinical Psychology Review.2001.21(7):971-988.
11. Einar Kjelsas et al. Prevalence of Eating Disorders in Female and Male Adolescents (14-15 years)[J]. Eating Behaviors.2004.5:13-25.
12. Fairburn C G, Brownell K D. Eating Disorders and Obesity:A Comprehensive Textbook. New York:Guilford Press.2002.
13. Fairburn C G, Cooper Z, Doll H A, Welch S L. Risk Factors for Anorexia Nervosa: Three Integrated Case-control Comparisons[J].Archives of General Psychiatry. 1999.56:468-476.
14. Garner et al. Psychological Medicine.1982.12:871-878. (adapted by D. Garger with permission.EAT)
15. Graber J,A, Brooks-Gunn J, Paikoff R.L, Warren M.P. Prediction of Eating Problems:An 8-year Study of Adolescent Girls[J]. Developmental Psychology. 1994.30:823-834.
16. Jennifer J. Thomas, Lenny R. Vartanian. The Relationship between Eating Disorder Not Otherwise Specified(EDNOS) and Officially Recognized Eating Disorders:Meta-analysis and Implications for DSM[J]. Psychological Bulletin. 2009.135(3):407-433.
17. Jessica H. Baker, Hermine H. Maes et al. Genetic Risk Factors for Disordered Eating in Adolescent Males and Females[J]. Journal of Abnormal Psychology. 2009.118(3):576-586.
18. Keel PK, Brown TA. Update on Course and Outcome in Eating Disorders. International Journal of Eating Disorder.2010.43:195-204.
19. Kristine Godt. Personality Disorders in 545 Patients with Eating Disorders[J]. Eutopean Eating Disorders Review.2008.16:94-99.
20. Levitan, R. D.,Kaplan, A.S.,Joffe, R.T.,Levitt, A.J.,&Brown, G.M. Hormonal and Subjective Responses to Intravenous Metachlorophenylpiperazine in Bulimia Nervosa[J]. Archives of General Psychiatry.1997.54:521-527.
21. Naomi Chisuwa, Jennifer A. O'Dea. Body Image and Eating Disorders amongst Japanese Adolescents. A Review of the Literature[J]. Appetite.2010.54:5-15.
22. Riccardo Dalle Grave. Eating Disorders:Progress and Challenges[J]. Eurppean Journal of International Medicine.2011.1-7.
23. Rie R. Mitchell, Harriet S. Friedman. Sandplay:Past, Present, and Future. New York. Routledge.1994.
24. Robin F. Apple. Interpersonal Therapy for Bulimia Nervosa[J]. Psychotherapy in Practice.1999.55(6):715-725.
25. Russell G. Bulimia Nervosa:An Ominous Variant of Anorexia Nervosa[J]. Psychological Medicine.1979.9:429-448.
26. Shoebridge P, Gowers SG. Parental High Concern and Adolescent-onset Anrexia Nervosa:A case-control Study to Investigate Direction of Causality[J]. The British Journal of Psychiatry.2000.176:132-137.
27. Stephanie E. Cassin, Kristin M. von Ranson. Personality and Eating Disorders:A Decade in Review. Clinical Psychology Review.2005.25:895-916.
28. Stice E. Risk and Maintenance Factors for Eating Pathology:A Meta-analytic Review[J]. Psychological Bulletin.2002.128:825-848.
29. Tamburrino M B, Mcginnis R A. Anorexia Nervosa[J]. Panminerva Med.2002. 44(4):301.
30. Teresa Granillo, Gina Jones-Rodriguez, and Scott C. Carvajal. Prevalence of Eating Disorders in Latina Adolescents:Associations with Substance Use and other Correlates[J]. Journal of Adolescent Health.2005.36:214-220.
31. Ulrike Schmidt. Epidemiology and Aetiology of Eating Disorders[J]. Diognosis, Epidemiology and Aetiology,2005:5-9.
32. Wade T D, Bulik C K, Neale M, et al. Anorexia Nervosa and Major Depression: Shared Genetic and Environment Risk Factors[J]. American Journal of Psychiatry. 2000.157(3):469-471.
33. Walsh B. T.,Fairburn C. G, Mickley D.,Sysko R.,&Parides M. K. Treatment of Bulimia Nervosa in a Primary Care Setting[J]. American Journal of Psychiatry. 2004.161:556-561.
34. Walter Kaye, Michael Strober, Daniel Stein, and Kelly Gendall. New Directions in Treatment Research of Anorexia and Bulimia Nervosa[J].Biological Psychiatry. 1999.45:1285-1292.
35. Welch S.L, Doll H.A, Fairburn CG. Life Events and the Onset of Bulimia Nervosa:A Controlled Study[J]. Psychological Medicine.1997.27:515-522.
36. Yates A. Edman J, Arugueste M. Ethnic Differences in BMI and Body/Self-dissatisfaction among Whites, Asian subgroups, Pacific Islanders, and African[J]. Adolescence Health.2004.34(4):300-307.
37.陈清刚.进食障碍与社会心理因素[J].中国行为医学科学.2006.15(11)：1053-1054.
38.陈顺森,张日异,徐洁.团体箱庭疗法干预初中生考试焦虑的效果[J].心理与行为研究.2006.4.
39.范青,马玮亮,季建林.女性进食障碍的心理社会学因素研究[J].心理行为研究.2005.16(1)：55-57.
40.范国平,高岚,李江雪.“沙盘游戏”的理论分析及其在幼儿教育中的应用研究[J].心理学探新.2003.23(2)：51-54.
41.吉封,杨丽,卢国华等译. Jeffrey S. Nevid Spencer A.Rathus Beverly Greene著,变态心理学一变化世界中的视角.华东师范大学出版社.
42.赖小林,巢东蕊,丁成文.沙盘游戏疗法的应用及研究现状[J].中国健康心理学杂志.2010.18(6)：754-756.
43.柳娜,张亚林,贺达仁.进食障碍发病机制的研究紧张与思考[J].医学与哲学(临床决策论坛版).2009.30(9)：52-54.
44.陆晓花,张宁.进食障碍的亚临床状态[J].中国心里卫生杂志.2006.20(6)：381-383.
45.陆晓花.青少年进食行为与进食障碍研究.南京：南京师范大学.2006.
46.李婧,徐艺珊,李新宇.大学生非典型性进食障碍与身体自尊的关系研究[J].中国临床心理学杂志.2009.17(3)：345-347.
47.李秀亮.进食障碍的病因及治疗[J].中国健康心理学杂志.2010.18(5)：633-635.
48.申荷永,陈侃,高岚.沙盘游戏治疗的历史与理论[J].心理发展与教育.2005.2：124-128.
49.申荷永,高岚.沙盘游戏：理论与实践[M].广东：高等教育出版社.2004.
50.申荷永.心理分析[M].三联出版社.2004.
51.桑园,谢玮.神经性贪食症的成因及治疗[J].校园心理.2010.8(6)：396-397.
52.苏小路,余小鸣.进食障碍的流行现状、影响因素和预防措施[J].国外医学卫生学分册.2008.35(4)：240-243.
53.武萌,武成莉.进食障碍影响因素的探讨[J].社会心理科学.2006.86(4)：472-475.
54.徐光兴.临床心理学一心理咨询的理论与技术[M].上海：上海教育出版社.2009.
55.徐强.从心理学视角探讨进食障碍的成因[J].桂林师范高等专科学校学报.2010.24(1)：113-116.
56.喻东山.神经性贪食症的治疗模式[J].中国民政医学杂 志.2000.12(6)：354-356.
57.张雯,刘亚茵,张日异.团体箱庭疗法对人际交往不良大学生的治疗过程与效果研究[J].中国临床心理学杂志.2010.18(2)：264-268.
58.张雯,张日昇,孙凌.近十年来箱庭疗法在中国的研究新进展[J].心理科学.2010.33(2)：390-392.
59.章晓云,钱铭怡.进食障碍的心理干预[J].中国心理卫生杂志.2004.18(1)：31-33.
60.张日异.箱庭疗法.心理科学.1998.21(6)：544-547.
61.张日异.箱庭疗法[M].北京：人民教育出版社.2008.
62.钱铭怡,刘鑫.北京女大学生节食状况及进食障碍状况的初步调查[J].中国心理卫生杂志.2002.16(11)：753-757.
63.周朝昀,陈珏.进食障碍的危险因素研究进展[J].国际精神病学杂志.2010.37(2)：100-103.
64.张雯,刘亚茵,张日异.团体箱庭疗法对人际交往不良大学生的治疗过程与效果研究[J].中国临床心理学杂志.2010.18(2)：264-268.
2. Bulik C M, Sullivan P F, Wade T D, et al. Twin Studies of Eating Disorders:A Review[J]. International Journal of Eating Disorder.2000.27(1):1-20.
3. Carl Jung. Archetypes and the Collective Unconscious. Princeton:Princeton University Press.1977.
4. Cognitive Behavior Therapy and Eating Disorders.Christopher G. Fairburn. New York. The Guilford Press.2008.
5. Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, et al.Increased Mortality in Bulimia Nervosa and Other Eating Disorders[J]. American Journal of Psychiatry.2009.130:1342-1346.
6. Daisuke Yasuhara, Naoko Homan, Nobuatsu Nagai et al,A Significant Nationwide Increase in the Prevalence of Eating Disorders in Japan:1998-year Survey[J]. International Congress Series.2002.1241:297-301.
7. Daniel le Grange, James Lock et al. Academy for Eating Disorders Position Paper: the Role of the Family in Eating Disorders[J]. International Journal of Eating Disorders.2010.43(1):1-5.
8. Dora Kalff. Sandplay:A Psychotherapeutic Approach to the Psyche. Sigo Press, 1980.
9. Dora Kalff. Foreword. In Katherine Bradway. Sandplay Studies:Origins, Theory & Practice. Boston:Sigo Press.1990.
10. Drew A. Anderson, Kathleen C. Maloney. The Efficacy of Cognitive-behavioral Therapy on the Core Symptoms of Bulimia Nervosa[J]. Clinical Psychology Review.2001.21(7):971-988.
11. Einar Kjelsas et al. Prevalence of Eating Disorders in Female and Male Adolescents (14-15 years)[J]. Eating Behaviors.2004.5:13-25.
12. Fairburn C G, Brownell K D. Eating Disorders and Obesity:A Comprehensive Textbook. New York:Guilford Press.2002.
13. Fairburn C G, Cooper Z, Doll H A, Welch S L. Risk Factors for Anorexia Nervosa: Three Integrated Case-control Comparisons[J].Archives of General Psychiatry. 1999.56:468-476.
14. Garner et al. Psychological Medicine.1982.12:871-878. (adapted by D. Garger with permission.EAT)
15. Graber J,A, Brooks-Gunn J, Paikoff R.L, Warren M.P. Prediction of Eating Problems:An 8-year Study of Adolescent Girls[J]. Developmental Psychology. 1994.30:823-834.
16. Jennifer J. Thomas, Lenny R. Vartanian. The Relationship between Eating Disorder Not Otherwise Specified(EDNOS) and Officially Recognized Eating Disorders:Meta-analysis and Implications for DSM[J]. Psychological Bulletin. 2009.135(3):407-433.
17. Jessica H. Baker, Hermine H. Maes et al. Genetic Risk Factors for Disordered Eating in Adolescent Males and Females[J]. Journal of Abnormal Psychology. 2009.118(3):576-586.
18. Keel PK, Brown TA. Update on Course and Outcome in Eating Disorders. International Journal of Eating Disorder.2010.43:195-204.
19. Kristine Godt. Personality Disorders in 545 Patients with Eating Disorders[J]. Eutopean Eating Disorders Review.2008.16:94-99.
20. Levitan, R. D.,Kaplan, A.S.,Joffe, R.T.,Levitt, A.J.,&Brown, G.M. Hormonal and Subjective Responses to Intravenous Metachlorophenylpiperazine in Bulimia Nervosa[J]. Archives of General Psychiatry.1997.54:521-527.
21. Naomi Chisuwa, Jennifer A. O'Dea. Body Image and Eating Disorders amongst Japanese Adolescents. A Review of the Literature[J]. Appetite.2010.54:5-15.
22. Riccardo Dalle Grave. Eating Disorders:Progress and Challenges[J]. Eurppean Journal of International Medicine.2011.1-7.
23. Rie R. Mitchell, Harriet S. Friedman. Sandplay:Past, Present, and Future. New York. Routledge.1994.
24. Robin F. Apple. Interpersonal Therapy for Bulimia Nervosa[J]. Psychotherapy in Practice.1999.55(6):715-725.
25. Russell G. Bulimia Nervosa:An Ominous Variant of Anorexia Nervosa[J]. Psychological Medicine.1979.9:429-448.
26. Shoebridge P, Gowers SG. Parental High Concern and Adolescent-onset Anrexia Nervosa:A case-control Study to Investigate Direction of Causality[J]. The British Journal of Psychiatry.2000.176:132-137.
27. Stephanie E. Cassin, Kristin M. von Ranson. Personality and Eating Disorders:A Decade in Review. Clinical Psychology Review.2005.25:895-916.
28. Stice E. Risk and Maintenance Factors for Eating Pathology:A Meta-analytic Review[J]. Psychological Bulletin.2002.128:825-848.
29. Tamburrino M B, Mcginnis R A. Anorexia Nervosa[J]. Panminerva Med.2002. 44(4):301.
30. Teresa Granillo, Gina Jones-Rodriguez, and Scott C. Carvajal. Prevalence of Eating Disorders in Latina Adolescents:Associations with Substance Use and other Correlates[J]. Journal of Adolescent Health.2005.36:214-220.
31. Ulrike Schmidt. Epidemiology and Aetiology of Eating Disorders[J]. Diognosis, Epidemiology and Aetiology,2005:5-9.
32. Wade T D, Bulik C K, Neale M, et al. Anorexia Nervosa and Major Depression: Shared Genetic and Environment Risk Factors[J]. American Journal of Psychiatry. 2000.157(3):469-471.
33. Walsh B. T.,Fairburn C. G, Mickley D.,Sysko R.,&Parides M. K. Treatment of Bulimia Nervosa in a Primary Care Setting[J]. American Journal of Psychiatry. 2004.161:556-561.
34. Walter Kaye, Michael Strober, Daniel Stein, and Kelly Gendall. New Directions in Treatment Research of Anorexia and Bulimia Nervosa[J].Biological Psychiatry. 1999.45:1285-1292.
35. Welch S.L, Doll H.A, Fairburn CG. Life Events and the Onset of Bulimia Nervosa:A Controlled Study[J]. Psychological Medicine.1997.27:515-522.
36. Yates A. Edman J, Arugueste M. Ethnic Differences in BMI and Body/Self-dissatisfaction among Whites, Asian subgroups, Pacific Islanders, and African[J]. Adolescence Health.2004.34(4):300-307.
37.陈清刚.进食障碍与社会心理因素[J].中国行为医学科学.2006.15(11)：1053-1054.
38.陈顺森,张日异,徐洁.团体箱庭疗法干预初中生考试焦虑的效果[J].心理与行为研究.2006.4.
39.范青,马玮亮,季建林.女性进食障碍的心理社会学因素研究[J].心理行为研究.2005.16(1)：55-57.
40.范国平,高岚,李江雪.“沙盘游戏”的理论分析及其在幼儿教育中的应用研究[J].心理学探新.2003.23(2)：51-54.
41.吉封,杨丽,卢国华等译. Jeffrey S. Nevid Spencer A.Rathus Beverly Greene著,变态心理学一变化世界中的视角.华东师范大学出版社.
42.赖小林,巢东蕊,丁成文.沙盘游戏疗法的应用及研究现状[J].中国健康心理学杂志.2010.18(6)：754-756.
43.柳娜,张亚林,贺达仁.进食障碍发病机制的研究紧张与思考[J].医学与哲学(临床决策论坛版).2009.30(9)：52-54.
44.陆晓花,张宁.进食障碍的亚临床状态[J].中国心里卫生杂志.2006.20(6)：381-383.
45.陆晓花.青少年进食行为与进食障碍研究.南京：南京师范大学.2006.
46.李婧,徐艺珊,李新宇.大学生非典型性进食障碍与身体自尊的关系研究[J].中国临床心理学杂志.2009.17(3)：345-347.
47.李秀亮.进食障碍的病因及治疗[J].中国健康心理学杂志.2010.18(5)：633-635.
48.申荷永,陈侃,高岚.沙盘游戏治疗的历史与理论[J].心理发展与教育.2005.2：124-128.
49.申荷永,高岚.沙盘游戏：理论与实践[M].广东：高等教育出版社.2004.
50.申荷永.心理分析[M].三联出版社.2004.
51.桑园,谢玮.神经性贪食症的成因及治疗[J].校园心理.2010.8(6)：396-397.
52.苏小路,余小鸣.进食障碍的流行现状、影响因素和预防措施[J].国外医学卫生学分册.2008.35(4)：240-243.
53.武萌,武成莉.进食障碍影响因素的探讨[J].社会心理科学.2006.86(4)：472-475.
54.徐光兴.临床心理学一心理咨询的理论与技术[M].上海：上海教育出版社.2009.
55.徐强.从心理学视角探讨进食障碍的成因[J].桂林师范高等专科学校学报.2010.24(1)：113-116.
56.喻东山.神经性贪食症的治疗模式[J].中国民政医学杂 志.2000.12(6)：354-356.
57.张雯,刘亚茵,张日异.团体箱庭疗法对人际交往不良大学生的治疗过程与效果研究[J].中国临床心理学杂志.2010.18(2)：264-268.
58.张雯,张日昇,孙凌.近十年来箱庭疗法在中国的研究新进展[J].心理科学.2010.33(2)：390-392.
59.章晓云,钱铭怡.进食障碍的心理干预[J].中国心理卫生杂志.2004.18(1)：31-33.
60.张日异.箱庭疗法.心理科学.1998.21(6)：544-547.
61.张日异.箱庭疗法[M].北京：人民教育出版社.2008.
62.钱铭怡,刘鑫.北京女大学生节食状况及进食障碍状况的初步调查[J].中国心理卫生杂志.2002.16(11)：753-757.
63.周朝昀,陈珏.进食障碍的危险因素研究进展[J].国际精神病学杂志.2010.37(2)：100-103.
64.张雯,刘亚茵,张日异.团体箱庭疗法对人际交往不良大学生的治疗过程与效果研究[J].中国临床心理学杂志.2010.18(2)：264-268.