地震创伤后应激障碍学生沙盘游戏干预模式的建立及效果检验

发布时间：2018-05-01 18:00

本文选题：创伤后应激障碍 + 干预模式　；参考：《云南师范大学》2015年硕士论文

【摘要】：2014年8月3日16时30分在云南省昭通市鲁甸县发生了6.5级的地震。由于此次地震震级高,震源浅,当地人口密度稠密,地形地质情况复杂、次生灾害丛生以及经济发展状况等因素,此次地震给鲁甸县带来了惨重的人员伤亡和巨大的经济损失,并且对灾区人民的心灵造成了严重的心理创伤。面对灾难的突然发生,会引起人类一系列的应激反应,包括生理和心理上的不适,心理上会有恐慌、焦虑、恐惧、脆弱、罪恶感、孤独、意志消沉(包括有自杀的企图)、愤怒和挫折感等多种反应,若是这些反应没有得到及时处理,则会发展成创伤后应激障碍(PTSD)。创伤后应激障碍的影响可能持续数月,经历长久的时间也难以化解,有的甚至影响终身。创伤后应激障碍的主要症状为回避性症状、闯入性症状、认知和心境的负性改变以及警觉性增高症状等。在患有PTSD的群体中,学生群体是较为特殊与庞大的一类群体,他们由于处于身心发展的关键期,发育尚不成熟,也没有成年人相对完善的应对机制,PTSD对他们的影响尤为突出,一旦在这一时期受影响,会对终身的心理健康造成难以逆转的改变。本研究采用问卷调查法对鲁甸县极重灾区的灾区中学生的PTSD现状进行调查,从中筛查出PTSD严重的学生,并结合绘画投射测验、班主任推荐和邀请性访谈的结果,确定干预对象,并使用本研究构建的地震后PTSD学生沙盘游戏治疗和绘画治疗的干预模式对其进行心理干预。问卷使用云南省社会心理学会根据DSM-5最新标准修订的《DSM-5学生PTSD调查问卷》,数据收集后使用spssl8.0进行数据分析,数据结果分析采用独立样本T检验、配对样本T检验等分析方法。最终确定70名干预对象,进行地震后PTSD学生沙盘游戏治疗和绘画治疗干预模式的干预。问卷前测结果显示:地震灾后PTSD学生的主要症状较为严重的是闯入性症状,其次是回避症状、唤醒和反应改变和社会功能受损,认知与心境负性改变。且在总分上存在性别和年级差异,表现为女生得分高于男生,初一年级学生得分高于初二年级学生得分。通过理论分析、干预模式建立、干预实施和结果分析,本研究得出以下结论:结论一:震后学生PTSD量表检出率存在男女差异,女生的PTSD量表得分要高于男生,并且在闯入性症状、回避性症状、认知与负性改变症状上,女生要比男生得分更高。结论二:震后学生PTSD检出率存在年级差异,初一年级学生的PTSD量表得分要高于初二学生,且在总分和闯入性症状、回避症状、认知与心境负性改变三个维度上存在有显著差异。结论三:经过沙盘游戏和绘画治疗干预模式的干预,地震灾区PTSD干预组的学生量表分数显著降低,说明干预模式有效。结论四:经过本研究干预模式的干预,震后灾区学生的PTSD症状有明显治愈效果,特别是在闯入性症状、认知与心境负性改变以及唤醒和反应改变三个维度上。
[Abstract]:An earthquake of magnitude 6.5 occurred at 16:30 on August 3, 2014 in Ludian County, Zhaotong City, Yunnan Province. Due to such factors as high magnitude, shallow focus, dense local population, complex topography and geological conditions, numerous secondary disasters and economic development, the earthquake has brought heavy casualties and huge economic losses to Ludian County. And has caused serious psychological trauma to the people in the disaster area. In the face of a sudden disaster, it can cause a series of stress reactions, including physical and psychological discomfort, psychological panic, anxiety, fear, vulnerability, guilt, loneliness, Depression (including suicidal attempts, anger, frustration, etc.) can develop into PTSD if these reactions are not dealt with in time. The effects of post-traumatic stress disorder may last for months, and long periods of time can be difficult to overcome, and some may even affect life. The main symptoms of post-traumatic stress disorder are avoidance symptoms, intrusive symptoms, negative changes in cognition and mood, and increased alertness. In the group with PTSD, the student group is a special and large group, because they are in the critical period of physical and mental development, their development is not mature, and there is no relatively perfect coping mechanism for adults. Once affected during this period, it can cause irreversible changes in mental health for life. This research uses the questionnaire method to investigate the PTSD status of the middle school students in the disaster area of Ludian County, and screen out the students with serious PTSD, and combine the results of the painting projection test, the head teacher's recommendation and the invite interview, to determine the intervention object. The intervention models of sand game therapy and painting therapy for PTSD students after earthquake were used in this study. The questionnaire was based on the PTSD questionnaire of DSM-5 students revised by Yunnan Society of Social Psychology according to the latest standard of DSM-5. The data were analyzed by spssl8.0 after data collection. The data results were analyzed by independent sample T test and paired sample T test. Finally, 70 subjects were selected for intervention of sand table therapy and painting therapy for PTSD students after the earthquake. The results of pre-questionnaire test showed that the main symptoms of PTSD students after earthquake disaster were intrusive symptoms, followed by avoidance symptoms, arousal and reaction changes and impaired social function, cognitive and mood negative changes. There are gender and grade differences in the total score, which shows that the female students score higher than the boys, and the junior high grade students score higher than the second grade students. Through theoretical analysis, intervention model establishment, intervention implementation and result analysis, this study draws the following conclusions: first, there is a difference between men and women in the detection rate of PTSD scale for students after the earthquake, and the score of PTSD scale for girls is higher than that for boys. And girls scored higher than boys in intrusive symptoms, avoidance symptoms, cognitive and negative changes. Conclusion: there is grade difference in the detection rate of PTSD in the students after the earthquake. The scores of PTSD scale of the first grade students are higher than those of the second grade students, and there are significant differences in the total score, the intrusive symptom, the avoidance symptom, the cognition and the negative mood change. Conclusion: after the intervention of sand game and painting therapy, the scores of PTSD intervention group were significantly decreased, which indicated that the intervention model was effective. Conclusion: through the intervention model of this study, the PTSD symptoms of the students in the disaster areas after the earthquake can be cured obviously, especially in the three dimensions of intrusive symptoms, negative cognitive and mood changes, and arousal and response changes.
【学位授予单位】：云南师范大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：B845.67

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