基于忆溯性方法的中医心理疗法治疗抑郁症的临床研究
发布时间：2018-08-11 10:15
【摘要】：研究背景“三才”指个体的生存环境,中医心理学的“三才整体论”强调个体所处的社会环境对其心理健康的影响,并认为很多的情志疾病都与患者所处环境有关。抑郁症是一种以心境低落为主要特征的精神心理疾病,属于中医“郁病”范畴,终身患病风险率达17-19%,严重影响到患者及家属的生活、工作,世界卫生组织预测,到2020年,抑郁症将成为全球第二大疾病负担。己有研究显示抑郁症发病过程中环境造成的应激因素发挥了非常重要的作用,而对个体产生影响的各种事件成为生活经历存储在其记忆中,因此针对记忆的诊疗方法在抑郁症的心理诊疗方面具有重要意义。中医心理忆溯性方法,就是通过记忆回溯进行中医心理研究与治疗的方法。中医心理低阻抗意念导入疗法(TIP)、提纲式作业、忆溯性人格发展量表(WMPI)等都是基于忆溯性方法创立的治疗或评估方法。TIP是通过气功入静方式将患者导入低阻抗状态中,进行意念导入,重点对患者以往经历进行治疗的中医心理治疗方法;提纲式作业是要求患者按照提纲回忆并书写人生经历的病史资料收集方法;WMPI是根据被试的回忆评估各个年龄阶段人格要素发展水平的心理测量工具;临床上此三者在抑郁症的诊疗中起到重要作用。前期研究发现基于忆溯性方法的中医心理TIP疗法对于抑郁症有较好的临床疗效,但是关于TIP疗法的对于抑郁症的心理治疗机制研究,目前依然是空白。目的明确基于忆溯性方法的中医心理低阻抗意念导入疗法(TIP)对于抑郁症的治疗效果,探索TIP疗法对于抑郁症的心理治疗机制;并探讨中医心理忆溯性方法在抑郁症临床诊疗方面的意义。方法本研究以60例轻中度抑郁症患者为研究对象,随机分为研究组和对照组,研究组采用基于忆溯性方法的中医心理低阻抗意念导入疗法(ITP),对照组采用认知行为疗法(CBT),对入组患者进行12周的心理治疗。研究工具包括诊断工具DSM-ⅣV及半结构定式访谈SCID,测评工具24项汉密尔顿抑郁量表(HAMD-24),汉密尔顿焦虑量表(HAMA),贝克抑郁评定量表(BDI),忆溯性人格发展量表(WMPI)。治疗前、治疗第4、8、12周以及治疗结束后3个月,进行HAMD、HAMA、BDI检查以明确心理治疗对抑郁症的治疗效果;治疗前以及治疗第12周进行WMPI检查,以研究心理治疗对于抑郁症人格要素的影响;治疗前以及治疗12周TIP组患者完成两次提纲式作业,通过提纲式作业的质性分析研究患者对于TIP治疗的主观反应及反馈。分析方法包括提纲式作业的质性分析方法,以及使用SPSS22.0统计软件进行病例基本情况、基线统计、疗效指标的组内组间比较分析等。结果1.治疗有效率12周治疗结束时两组主要疗效指标HAMD得分较治疗前均有明显下降(P0.01),根据有效率统计,TIP组总有效率为80%,CBT组总有效率为66.7%,TIP组有效率与CBT组有明显差异(P0.05)。治疗结束后3月随访时,两组均未见服用抗抑郁药物或接受治疗患者,组内比较两组随访时HAMD得分与该组治疗前均保持差异(P0.01),且TIP组随访时HAMD得分与该组治疗后相比,有进一步下降(P0.05),组间比较TIP组随访时HAMD得分优于CBT组(P0.01)。2.HAMD、HAMA以及BDI改善情况经过治疗,除CBT组在HAMD体重因子分及HAMA躯体焦虑因子分未见明显变化以外,两组在HAMD、HAMA、BDI总分以及各个因子分经过治疗都有明显改善(P0.05)。治疗4周时,在HAMA精神焦虑因子分以及总分TIP组与CBT组开始出现明显差异(P0.05)。治疗8周时,在HAMA躯体焦虑因子分,HAMD焦虑/躯体化因子分、日夜变化因子分,以及BDI总分,TIP组与CBT组开始出现明显差异(P0.05)。第12周治疗结束时,在HAMD迟缓因子分TIP组与CBT组开始出现明显差异(P0.05)。治疗后3月随访时,TIP组与CBT组在HAMD总分和认知障碍因子分出现明显差异(P0.05)。以上差异均是TIP组得分优于CBT组,且差异持续至随访。在HAMD睡眠障碍、绝望感和体重因子分方面两组未出现明显差异(P0.05)。3.WMPI异常人格要素数量变化治疗后TIP组和CBT组在WMPI异常人格要素总数方面较治疗前均有所减少(P0.05)。治疗后TIP组异常人格要素总数少于CBT组(P0.05)。从年龄段角度分析,治疗后TIP组在童年、少年、青年各时期异常人格数较治疗前均有减少(P0.05),CBT组在青年期异常人格要素个数较治疗前有所减少(P0.05),治疗后TIP组在童年期和少年期异常人格要素数量方面较CBT组少(P0.05)。从人格要素角度统计,治疗后TIP组在意志、教养方式、胆气、自知、思虑方面异常人格要素数量较治疗前有所减少(P0.05),CBT组治疗前后未出现明显差异(P0.05)。4.TIP组提纲式作业质性分析结果(1)事件数量的变化提纲式作业的质性分析发现,在整体字数、事件数方面,治疗后提纲式作业都较疗前明显减少(P0.05)。按年龄段分析,少年、青年、近期事件较疗前有减少(P0.05),童年、成年期事件数量未见差异(P0.05)。按事件类型分析,疗后负性的家庭、社会、学习工作以及个人事件较疗前减少明显(P0.05),负性教养事件和正性事件无差异(P0.05)。按伴随情绪分析,疗后伴随怒、恐、悲、忧情绪的事件较疗前减少明显(P0.05),伴随喜情绪的事件未见差异(P0.05)。(2)具体事件的变化同一事件在治疗前后的提纲式作业中出现认知、伴随的情绪表达方面的变化,包括伴随情绪的更加平和与开放,认知方面包括对负性事件的接纳,以及对现实问题更加多视角、理性、具体地思考与解决。(3)治疗反馈在患者治疗后提纲式作业中对于治疗的反馈包含对于治疗方法、收获感悟以及症状改善三个方面的内容。患者提及的收获感悟包括对抑郁症的认识,对于人生的认识,对负性事件、自身的缺点的接纳,以及自我能力的提升等等;症状改善包括抑郁情绪、躯体症状、焦虑、自卑以及自罪的改善等。结论1、基于忆溯性方法的中医心理低阻抗意念导入疗法(TIP)对于轻中度抑郁症有较好的治疗效果,能够降低汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、贝克抑郁评定量表(BDI)总分以及各项因子分,有效改善抑郁症状,治疗结束后有持续改善效果,效果较认知行为疗法(CBT)更具优势,且随访时优势明显。2、基于忆溯性方法的中医心理低阻抗意念导入疗法(TIP)对于轻中度抑郁症人格素质或易感性有改善作用,忆溯性人格发展量表(WMPI)显示TIP疗法可减少抑郁症患者异常人格要素数量,提纲式作业显示治疗后患者对记忆中事件的情绪、认知等发生变化。3、基于忆溯性方法的中医心理低阻抗意念导入疗法(TIP)对于抑郁症的心理治疗机制是通过气功入静的方式,降低患者阻抗,深入患者元神与记忆,利用具象思维调动感知觉,运用忆溯性方法,针对患者记忆进行意念信息的导入,并且通过元神影响识神、欲神,改变患者抑郁情绪以及不良认知行为,改善抑郁症的人格易感性,从而起到治疗作用。各种技术包括放松诱导降低阻抗;通过忆溯性共情宣泄患者不良情绪;通过忆溯性病史分析使患者了解抑郁症发病路线并配合治疗;通过忆溯性再成长纠正人格要素的缺失和偏移;通过与忆溯性方法配合的行为治疗以及对症治疗纠正不良行为激发良好行为,并且缓解抑郁症的躯体症状。4、中医心理忆溯性方法针对抑郁症的心理病机,在中医学三因制宜、治病求本的理论指导下,通过对患者记忆进行研究,探索发病路线及人格易感性,并且针对其过去经历进行忆溯性中医心理治疗,在抑郁症的临床诊疗中具有重要意义。
[Abstract]:Background The "three talents" refers to the individual's living environment. The "three talents holism" of TCM psychology emphasizes the influence of the social environment on the mental health of the individual, and holds that many emotional diseases are related to the environment of the patient. The World Health Organization predicts that depression will become the second largest disease burden in the world by 2020. Studies have shown that environmental stressors play a very important role in the onset of depression and affect individuals. Various events are stored in the memory of life experience, so the diagnosis and treatment of memory is of great significance in the psychological diagnosis and treatment of depression. Traceable Personality Development Inventory (WMPI) is a retrospective treatment or evaluation method. TIP is a method of introducing patients into low impedance state through Qigong static state, with the emphasis on the traditional Chinese medicine psychotherapy for the treatment of patients'past experience. The outline task requires patients to recall and write according to the outline. WMPI is a psychometric tool for assessing the development level of personality factors in different age stages based on the subjects'recall. These three factors play an important role in the diagnosis and treatment of depression. Objective To clarify the effect of low impedance ideation introduction therapy (TIP) based on retrospective method for depression, explore the mechanism of TIP therapy for depression, and explore the inhibition of retrospective method for depression. Methods A total of 60 patients with mild to moderate depression were randomly divided into the study group and the control group. The study group was treated with low impedance ideation introduction therapy (ITP) based on retrospective method, and the control group was treated with cognitive behavioral therapy (CBT) for 12 weeks. The tools included diagnostic tools DSM-IVV and semi-structured interview SCID, 24 items of Hamilton Depression Scale (HAMD-24), Hamilton Anxiety Scale (HAMA), Beck Depression Rating Scale (BDI), Retrospective Personality Development Scale (WMPI). WMPI was performed before and 12 weeks after psychotherapy to study the effect of psychotherapy on personality factors of depression. The TIP group completed two outline tasks before and 12 weeks after treatment. The subjective reaction and reaction to TIP were analyzed by qualitative analysis of outline task. Results 1. The HAMD scores of the two groups at the end of 12 weeks of treatment were significantly lower than those before treatment (P 0.01), according to the effective rate. 2. The total effective rate was 80% in the TIP group, 66.7% in the CBT group and 66.7% in the TIP group (P 0.05). The scores of HAMD, HAMA and BDI in TIP group were better than those in CBT group (P 0.01). After treatment, the scores of HAMD, HAMA and BDI in TIP group were lower than those in CBT group (P 0.05). Except that the scores of HAMD body weight factor and HAMA somatic anxiety factor in CBT group were not significantly changed, the scores of HAMD, HAMA, BDI and the scores of each factor in both groups were treated. After 4 weeks of treatment, there were significant differences between HAMA, TIP and CBT (P 0.05). After 8 weeks of treatment, there were significant differences between HAMA, HAMD, day and night, BDI, TIP and CBT (P 0.05). At the end of treatment, there was a significant difference in the HAMD retardation factor score between TIP group and CBT group (P 0.05). At 3 months follow-up, there was a significant difference in total HAMD score and cognitive impairment factor score between TIP group and CBT group (P 0.05). There was no significant difference between the two groups (P 0.05). 3. After treatment, the total number of abnormal personality elements in TIP group and CBT group decreased (P 0.05). After treatment, the total number of abnormal personality elements in TIP group was less than that in CBT group (P 0.05). The number of abnormal personality factors in adolescence in CBT group was lower than that before treatment (P 0.05). After treatment, the number of abnormal personality factors in childhood and adolescence in TIP group was less than that in CBT group (P 0.05). There was no significant difference between the CBT group and the CBT group before and after treatment (P 0.05). 4. The qualitative analysis results of the outline task in the TIP group (1) The qualitative analysis of the number of events in the outline task showed that the number of words and events decreased significantly after treatment (P 0.0). 5) According to the age group, the number of recent events in adolescents, youth and adults decreased (P 0.05), and there was no difference in the number of incidents in childhood and adulthood (P 0.05). After treatment, the incidents of anger, fear, sadness and anxiety were significantly less than those before treatment (P 0.05). There was no difference in the incidents of happiness (P 0.05). (2) The changes of specific events in the same event before and after treatment appeared cognition in the outline task, accompanied by changes in emotional expression, including more peaceful and open emotion, cognitive aspects. Including the acceptance of negative events, as well as a more realistic problem perspective, rational, specific thinking and solution. (3) Treatment feedback in patients after treatment outline work for the treatment of feedback includes three aspects of treatment methods, harvest perception and symptom improvement. Recognition, understanding of life, acceptance of negative events, acceptance of their own shortcomings, and improvement of self-ability, etc. Symptoms improvement includes depression, physical symptoms, anxiety, inferiority and self-guilt improvement. Conclusion 1, Low Impedance Psychological Impedance Implant Psychotherapy (TIP) based on recall traceability method is better for mild to moderate depression. Therapeutic effect can reduce the total scores of Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Beck Depression Rating Scale (BDI) and various factors, effectively improve the depressive symptoms, after treatment has a continuous improvement effect, the effect is more superior than cognitive behavioral therapy (CBT), and the advantage is obvious at follow-up. 2, based on the method of recall traceability. TCM low impedance ideation introduction therapy (TIP) can improve the personality quality or susceptibility of mild to moderate depression. Retrospective Personality Development Inventory (WMPI) shows that TIP therapy can reduce the number of abnormal personality elements in patients with depression. Outline work shows that after treatment, the emotion and cognition of memory events have changed. The mechanism of TCM low impedance mind introduction therapy (TIP) for depression is to reduce the patient's impedance, to go deep into the patient's mind and memory, to mobilize the perception by concrete thinking, to use the memory traceability method, to import the idea information for the patient's memory, and through the spirit of mind. Various techniques, including relaxation induction and reduction of impedance, catharsis of negative emotions through retrospective empathy, and understanding of the paths of depression through retrospective analysis of the history of sexually transmitted diseases, can be used to improve the personality susceptibility to depression. Recalling retrospective growth corrects the loss and deviation of personality elements; stimulating good behavior and alleviating physical symptoms of depression through behavioral therapy combined with retrospective method and symptomatic treatment to correct bad behavior. 4. TCM psychological retrospective method aims at the psychological pathogenesis of depression and treats the disease according to the three factors of TCM. Under the guidance of the theory, it is of great significance in the clinical diagnosis and treatment of depression to study the memory of patients, explore the route of onset and personality susceptibility, and carry out retrospective TCM psychotherapy for their past experience.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R277.7
[Abstract]:Background The "three talents" refers to the individual's living environment. The "three talents holism" of TCM psychology emphasizes the influence of the social environment on the mental health of the individual, and holds that many emotional diseases are related to the environment of the patient. The World Health Organization predicts that depression will become the second largest disease burden in the world by 2020. Studies have shown that environmental stressors play a very important role in the onset of depression and affect individuals. Various events are stored in the memory of life experience, so the diagnosis and treatment of memory is of great significance in the psychological diagnosis and treatment of depression. Traceable Personality Development Inventory (WMPI) is a retrospective treatment or evaluation method. TIP is a method of introducing patients into low impedance state through Qigong static state, with the emphasis on the traditional Chinese medicine psychotherapy for the treatment of patients'past experience. The outline task requires patients to recall and write according to the outline. WMPI is a psychometric tool for assessing the development level of personality factors in different age stages based on the subjects'recall. These three factors play an important role in the diagnosis and treatment of depression. Objective To clarify the effect of low impedance ideation introduction therapy (TIP) based on retrospective method for depression, explore the mechanism of TIP therapy for depression, and explore the inhibition of retrospective method for depression. Methods A total of 60 patients with mild to moderate depression were randomly divided into the study group and the control group. The study group was treated with low impedance ideation introduction therapy (ITP) based on retrospective method, and the control group was treated with cognitive behavioral therapy (CBT) for 12 weeks. The tools included diagnostic tools DSM-IVV and semi-structured interview SCID, 24 items of Hamilton Depression Scale (HAMD-24), Hamilton Anxiety Scale (HAMA), Beck Depression Rating Scale (BDI), Retrospective Personality Development Scale (WMPI). WMPI was performed before and 12 weeks after psychotherapy to study the effect of psychotherapy on personality factors of depression. The TIP group completed two outline tasks before and 12 weeks after treatment. The subjective reaction and reaction to TIP were analyzed by qualitative analysis of outline task. Results 1. The HAMD scores of the two groups at the end of 12 weeks of treatment were significantly lower than those before treatment (P 0.01), according to the effective rate. 2. The total effective rate was 80% in the TIP group, 66.7% in the CBT group and 66.7% in the TIP group (P 0.05). The scores of HAMD, HAMA and BDI in TIP group were better than those in CBT group (P 0.01). After treatment, the scores of HAMD, HAMA and BDI in TIP group were lower than those in CBT group (P 0.05). Except that the scores of HAMD body weight factor and HAMA somatic anxiety factor in CBT group were not significantly changed, the scores of HAMD, HAMA, BDI and the scores of each factor in both groups were treated. After 4 weeks of treatment, there were significant differences between HAMA, TIP and CBT (P 0.05). After 8 weeks of treatment, there were significant differences between HAMA, HAMD, day and night, BDI, TIP and CBT (P 0.05). At the end of treatment, there was a significant difference in the HAMD retardation factor score between TIP group and CBT group (P 0.05). At 3 months follow-up, there was a significant difference in total HAMD score and cognitive impairment factor score between TIP group and CBT group (P 0.05). There was no significant difference between the two groups (P 0.05). 3. After treatment, the total number of abnormal personality elements in TIP group and CBT group decreased (P 0.05). After treatment, the total number of abnormal personality elements in TIP group was less than that in CBT group (P 0.05). The number of abnormal personality factors in adolescence in CBT group was lower than that before treatment (P 0.05). After treatment, the number of abnormal personality factors in childhood and adolescence in TIP group was less than that in CBT group (P 0.05). There was no significant difference between the CBT group and the CBT group before and after treatment (P 0.05). 4. The qualitative analysis results of the outline task in the TIP group (1) The qualitative analysis of the number of events in the outline task showed that the number of words and events decreased significantly after treatment (P 0.0). 5) According to the age group, the number of recent events in adolescents, youth and adults decreased (P 0.05), and there was no difference in the number of incidents in childhood and adulthood (P 0.05). After treatment, the incidents of anger, fear, sadness and anxiety were significantly less than those before treatment (P 0.05). There was no difference in the incidents of happiness (P 0.05). (2) The changes of specific events in the same event before and after treatment appeared cognition in the outline task, accompanied by changes in emotional expression, including more peaceful and open emotion, cognitive aspects. Including the acceptance of negative events, as well as a more realistic problem perspective, rational, specific thinking and solution. (3) Treatment feedback in patients after treatment outline work for the treatment of feedback includes three aspects of treatment methods, harvest perception and symptom improvement. Recognition, understanding of life, acceptance of negative events, acceptance of their own shortcomings, and improvement of self-ability, etc. Symptoms improvement includes depression, physical symptoms, anxiety, inferiority and self-guilt improvement. Conclusion 1, Low Impedance Psychological Impedance Implant Psychotherapy (TIP) based on recall traceability method is better for mild to moderate depression. Therapeutic effect can reduce the total scores of Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Beck Depression Rating Scale (BDI) and various factors, effectively improve the depressive symptoms, after treatment has a continuous improvement effect, the effect is more superior than cognitive behavioral therapy (CBT), and the advantage is obvious at follow-up. 2, based on the method of recall traceability. TCM low impedance ideation introduction therapy (TIP) can improve the personality quality or susceptibility of mild to moderate depression. Retrospective Personality Development Inventory (WMPI) shows that TIP therapy can reduce the number of abnormal personality elements in patients with depression. Outline work shows that after treatment, the emotion and cognition of memory events have changed. The mechanism of TCM low impedance mind introduction therapy (TIP) for depression is to reduce the patient's impedance, to go deep into the patient's mind and memory, to mobilize the perception by concrete thinking, to use the memory traceability method, to import the idea information for the patient's memory, and through the spirit of mind. Various techniques, including relaxation induction and reduction of impedance, catharsis of negative emotions through retrospective empathy, and understanding of the paths of depression through retrospective analysis of the history of sexually transmitted diseases, can be used to improve the personality susceptibility to depression. Recalling retrospective growth corrects the loss and deviation of personality elements; stimulating good behavior and alleviating physical symptoms of depression through behavioral therapy combined with retrospective method and symptomatic treatment to correct bad behavior. 4. TCM psychological retrospective method aims at the psychological pathogenesis of depression and treats the disease according to the three factors of TCM. Under the guidance of the theory, it is of great significance in the clinical diagnosis and treatment of depression to study the memory of patients, explore the route of onset and personality susceptibility, and carry out retrospective TCM psychotherapy for their past experience.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R277.7
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