基于ACT的抑郁症计算机化治疗：效果、匹配及改变机制

发布时间：2018-01-29 04:47

本文关键词： 抑郁症计算机化心理治疗机制元分析潜在剖面分析潜变量增长曲线模型　出处：《华中师范大学》2012年博士论文　论文类型：学位论文

【摘要】：抑郁症患者未接受治疗通常带来慢性、周期性及消极影响,包括家庭及社会功能不良、躯体疾病、自杀意图和自杀行为等(McGorry, Purcell, Hickie,Jorm,2007; Merry, McDowell, Wild, et al.,2004).除了药物治疗与传统心理治疗,伴随着计算机科学的发展,越来越多研究者对抑郁症采用计算机化治疗的新模式加以探索,使得这个领域成为当前西方心理治疗研究领域的一个前沿和热点。本研究回顾了国内外抑郁症的病理学理论及治疗相关实证研究,接纳与承诺疗法(Acceptance and Commitment Therapy, ACT)和计算机化心理治疗。然后,采用元分析系统考察了抑郁症计算机化治疗的效果及影响因素；研发了基于ACT的计算机化治疗系统,并考察了对抑郁症的治疗效果及适用当事人的潜在类别最优匹配；用潜变量增长曲线模型(Latent growth curve modeling, LGM)考察基于ACT计算机化抑郁症治疗的作用机制。本研究的主体内容分为三部分。第一部分采用元分析与元回归分析技术,考察了抑郁症计算机化治疗的有效性及影响因素。来源于32篇文献,30项RCT研究的40个独立样本满足了元分析标准(N=4795)。研究结果表明：(1)抑郁症计算机化治疗是有效的。其整体效果接近于中等效果量,在青少年群体中效果量较小,而成人群体效果量较大,达到中等效果量；3个月追踪效果量为0.2,6个月追踪效果量为0.15。(2)亚组分析发现,所有亚组自我报告抑郁水平的后测值都有显著下降,但聚合效果量有差异。在抑郁严重程度、招募设置、支持方式和测量量表四个亚组分析中,效果量存在显著差异。在重症抑郁、社区样本、Email支持和采用其他测量量表的亚组中,其效果量显著高于其他分类组。出版年份、脱落率和干预单元数对治疗效果量有一定影响,但这些变量之间可能存在着交互作用,得出的结论需要谨慎对待。(3)研究可能存在出版偏差,但很难推翻现有结论。第二部分研发了基于ACT的计算机化治疗系统,并考察了对抑郁症的治疗效果及适用当事人的潜在类别最优匹配。采用校园广告招募的方式,通过施测BDI量表进行入组筛选,招募自评抑郁患者182名,采用随机对照组实验(治疗组95人；等待组87人),自助治疗组完成6单元的自助治疗,每周一单元,追踪3个月后自助治疗效果。研究结果表明：(1)基于ACT的计算机化治疗可以有效降低抑郁。与等待组相比较,ACT自助治疗组后测抑郁下降水平显著高于等待组,具有大效果量(d=1.27),3个月后的追踪调查仍然存在中等效果量(d=0.75)。(2)基于ACT的计算机化治疗还可以提升当事人的积极心理健康水平。与等待组相比较,ACT自助治疗组后测积极心理健康水平提升显著高于等待组,具有中等效果量(d=0.59),3个月追踪整体积极心理健康水平差异不显著,但情绪幸福感(d=0.55)和心理幸福感(d=0.54)仍具有中等效果量。(3)潜在剖面分析显示,基线抑郁、外倾性、内倾性、阻抗特质、性格、生物、童年和关系等8个当事人特征可以分为3个潜在类别,分别为高心理反应组(47%)、低心理反应组(37%)和内源性抑郁倾向组(16%)。(4)临床意义上的改变分析显示,高心理反应组治愈率最高,内源性抑郁倾向组治愈率最低,低心理反应组的可靠改变但未痊愈率最高,三组在无可靠改变率上无显著差异,这一结果在3个月后的追踪测量中仍保持一致。第三部分用LGM考察基于ACT计算机化抑郁症治疗的作用机制,主要分析了体验接纳与认知改变的中介效应。采用校园招募自评抑郁患者124名,采用随机对照组实验(治疗组63人；等待组61人),自助治疗组完成6单元的自助治疗。研究结果表明,(1)接受与行动、认知离解和功能失调态度在基于ACT的抑郁症计算机化治疗过程中都发生显著改变,自动化思维的改变不显著。体验回避在抑郁症ACT计算机化治疗中的中介效应显著,而认知改变的中介效应部分显著。(2)接受与行动、回避与融合、认知离解和功能失调态度,在治疗与抑郁症状改变之间的中介效应显著,也就是说,ACT计算机化治疗的作用机制在于接受与行动、回避与融合、认知离解和功能失调态度的改变,从而影响抑郁水平改变。(3)接受与行动、回避与融合和功能失调态度,在治疗与积极心理健康提升之间的中介效应显著,即ACT计算机化治疗的作用机制在于接受与行动、回避与融合和功能失调态度的改变,从而影响积极心理健康水平改变。综合讨论部分强调,在技术上应增加程序设计的互动性与智能性,加强个性化治疗,继续考察在其他人群的治疗效果,进一步探讨ACT计算机化抑郁症治疗的作用机制。
[Abstract]:Depressed patients did not receive treatment usually leads to chronic, periodic and negative effects, including family and social dysfunction, body disease, intention and behavior Dutch act Dutch Act (McGorry, Purcell, Hickie, Jorm, 2007; Merry, McDowell, Wild, et, al., 2004). In addition to traditional drug therapy and psychotherapy, accompanied by the development of computer science, more and more researchers to explore new mode of treatment of depression by computer, makes this area become a frontier and hot point in the research field of Western psychotherapy.
This study reviews the pathology of depression at home and abroad to learn the theory and treatment of relevant empirical research, acceptance and commitment therapy (Acceptance and Commitment Therapy, ACT) and computerized psychotherapy. Then, investigated the effect and influencing factors of depression treated by computerized element analysis system; research and development of computer management system based on ACT, and effects of latent class optimal treatment effect on depression and the application of the matching; growth curve model with latent variables (Latent growth, curve modeling, LGM) ACT study based on computerized mechanism of depression treatment. The main contents of this dissertation is divided into three parts.
The first part of the element analysis and regression analysis, investigates the effectiveness and influential factors of depression treatment. Computer from 32 articles, 30 RCT of the 40 independent samples meet the standard element analysis (N=4795). The results show that: (1) depression computerized treatment is effective. The overall effect is close to medium effect size effect is smaller in the youth group and adult group, the effect is large, medium effect; 3 months follow-up effect for 0.2,6 months tracking effect was 0.15. (2) subgroup analysis found that a subgroup of self-reported depression level measured value have decreased significantly, but the effect of polymerization levels were different. The recruitment is set in depression severity, support table four subgroup analysis and measurement, there are significant differences in the effect. Severe depression, community sample, Email support and the other measurement The scale of sub group, the effect was significantly higher than that in other classification groups. Year of publication, loss rate and intervention units have a certain influence on the treatment effect, but there are interactions between these variables, the conclusion needs to be treated with caution. (3) to study possible publication bias, but it is difficult to overthrow the existing conclusion.
The second part of the research and development of computer management system based on ACT, and investigated the potential categories of optimal treatment effect on depression and matching. The application of the campus recruitment advertising way, through the measurement of BDI scale in screening group, recruited 182 patients with self rating depression, randomized control group (experimental treatment group 95 people wait for 87 people); group, the treatment group completed 6 self-help self-help treatment unit, each unit on Monday, 3 months of follow-up after self treatment. The results show that: (1) computerized ACT treatment can effectively reduce depression. Based on comparison with the waiting group, ACT treatment group after self test of depression level the waiting group was significantly higher than that, with large effect size (d=1.27), 3 months follow-up after there is still medium effect size (d=0.75). (2) the computerized treatment of ACT could also increase the level of positive mental health. Based on the parties and etc. To be compared, ACT self treatment group post test positive mental health level was significantly higher than that of the waiting group, with moderate effect size (d=0.59), after 3 months, the difference in the overall level of positive mental health is not significant, but the emotional well-being (d=0.55) and psychological well-being (d=0.54) still has a moderate effect. (3) the potential profile analysis showed that baseline depression, extraversion and introversion, impedance characteristics, biological character, childhood and relationship between the 8 parties characteristics can be divided into 3 potential categories, respectively Gao Xinli group (47%), low response group (37%) and psychological reaction of endogenous depression group (16%). (4) clinical significance change analysis showed that high psychological reaction group the highest cure rate, cure rate of endogenous depression is lowest, reliable change low psychological reaction group but not recovery rate is highest, the three groups had no significant difference in the absence of reliable change rate, which results in the 3 months after the chase The tracer measurement remains consistent.
The third part examines the mechanism of action of ACT with LGM for the treatment of depression based on computer, mainly analyses the experience of acceptance and cognitive change. The mediating effect of campus recruitment self rating depression of 124 patients, randomized controlled experimental group (treatment group 63; for group 61), the treatment group completed 6 self-help self-help treatment unit. The results show that (1) and take action, cognitive dissociation and dysfunctional attitudes in significant changes have occurred during the treatment of depression in computer based on ACT. Automation of thinking did not change significantly. ACT computerized experiential avoidance in the depression in the treatment of a significant mediating effect, and the mediating effect of cognitive change significantly (2 part. Accept) and action, avoidance and fusion, cognitive dissociation and dysfunctional attitudes, the mediating effect between the treatment and depressive symptoms changed significantly, that is to say, the mechanisms of ACT computerized treatment Is to accept and act, avoidance and fusion, cognitive dissociation and dysfunctional attitude change, thus affecting the level of depression. (3) accept and act, avoidance and fusion and dysfunctional attitudes, the mediating effect between treatment and positive mental health improved significantly, the mechanism of ACT computerized treatment is to accept and act avoid, and fusion and dysfunctional attitude change, thus affecting the positive mental health level change.
The comprehensive discussion part emphasized that we should increase the interaction and intelligence of program design, enhance personalized treatment, continue to investigate the therapeutic effect in other populations, and further explore the mechanism of ACT computerized depression treatment.

【学位授予单位】：华中师范大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R749.4

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