心理动力学疗法和认知疗法的纵向平行研究

发布时间：2018-06-26 05:24

本文选题：心理动力学治疗 + 认知治疗　；参考：《中南大学》2014年硕士论文

【摘要】：目的：力求呈现心理动力学治疗与认知心理治疗全过程,确定其具体疗效及相关因素,对比两种心理疗法的异同。方法：本实验从课题“十种心理咨询与心理治疗的规范与示范研究”中选取心理动力学治疗与认知治疗两种疗法进行纵向平行对比。每种疗法均包含心理治疗+药物治疗组和单纯药物治疗组两组。评估治疗全过程中四个时点患者的多个观察指标,以及心理治疗师按照要求对所采用的每次心理治疗概括记录,通过对两组具体量化数据和心理治疗情况记录的分别分析,对比呈现两种心理治疗过程,并对治疗结果进行量化分析。采用软件SPSS18.0,进行独立样本t检验、卡方检验、重复测量的方差分析,logistic回归分析。结果： 1.心理动力学疗法量化数据分析显示SCL-90量表总分及因子分在两种处理间的差别有统计学意义(总分F=27.888,躯体化F=24.101,强迫F=9.826,人际关系F=8.502,抑郁F=11.412,焦虑F=18.727,敌对F=9.278,恐怖F=16.453,偏执F=4.487,精神病性F=4.904；P0.05)；GQOLI-74量表总分、躯体功能维度、心理功能维度在两种处理之间的差异具有统计学意义(总分F=11.381,P=0.001；躯体维度F=13.667,心理维度F=11.783；P0.05)。SCL-90减分率分析显示在治疗结束时、结束后三个月、结束后六个月时心理治疗组与药物治疗组的痊愈+显著好转人数均多于单纯药物治疗组(χ2=6.372,8.336,11.577；P0.05)。影响治疗效果改善因素的logistic回归分析显示最终进入方程的变量为试验分组,基线期GQOLI-74量表心理维度评分,基线期SSRS主观支持评分。 2.通过对心理动力学治疗过程的文本分析,了解治疗基本过程及治疗方案,发现在治疗过程中来访者主观评价情况除了在遇到“防御和阻抗”时有波动,基本维持稳定在“3”(稍进步)及以上水平,并可能对治疗效果的维持有预测作用。 3.认知疗法量化数据分析显示SCL-90量表总分(F=5.294,P=0.024)、人际敏感(F=4.396, P=0.039)、抑郁(F=5.715,P=0.019)、焦虑(F=4.659,P=0.034)、恐怖(F=7.404,P=0.008)、精神病性(F=8.651,P=0.004)在两种处理间的差别有统计学意义,且在不同时间点两组SCL-90总分及各因子分有差异。GQOLI-74量表总分(F=19.479,P=0.000)、躯体功能维度(P=11.988,T=0.001)、社会功能维度(F=26.326,P=0.000)在两种处理间差异有统计意义,且两组包括心理功能维度在内,以上各评分在不同时间点有差异。SSRS总分在不同时间点、不同处理方式的变化有差异(F=11.337,P=0.000)。SCL-90减分率分析显示治疗结束后六个月的痊愈+显著好转人数心理治疗组多于药物治疗组(χ2=6.873,P0.05)。影响治疗效果改善因素的logistic回归分析显示进入方程的变量为：试验分组,基线期GQOLI-74量表心理维度、基线SCSQ积极应付方式评分。 4.通过对认知治疗过程的文本分析,了解治疗基本过程及治疗技术,发现在进行“负性自动思维”的处理时来访者的主观评价有波动,其余时间基本稳定在“3”(稍进步)及以上水平,并可能对治疗效果的维持有预测作用。结论： 1.量化数据分析表明两种心理治疗结合药物治疗与单纯药物治疗相比疗效都更为显著,且疗效6个月内可维持。 2.除了接受心理治疗外,心理动力学治疗组中影响效果改善的因素还包括基线GQOLI-74心理维度及SSRS评分,认知疗法组中影响效果改善的因素还有基线GQOLI-74心理维度及SCSQ积极应付方式评分。 3.在心理动力学治疗过程中,来访者充分挖掘利用自身能力及资源满足自身的情感需求时,其躯体和心理症状会有所改善；而认知疗法症状的改善则出现在来访者学会识别并矫正中间信念和核心信念,并强化培养新的认知模式时。 4.两种心理治疗在治疗时长、治疗结构,以及治疗师的作用方面有所不同；但两种治疗方法同样以来访者为中心,且积极的主观评价和良好的治疗关系对治疗效果都能够起到促进作用。
[Abstract]:Objective:
Strive to present the whole process of psychodynamic therapy and cognitive psychotherapy, determine its specific efficacy and related factors, and compare the similarities and differences between the two psychotherapies.
Method:
In this experiment, we selected two kinds of psychodynamic therapy and cognitive therapy from ten kinds of psychological counseling and psychotherapy in a vertical parallel comparison. Each therapy includes two groups of psychotherapy + drug therapy group and simple drug treatment group. The multiple views of four time points in the whole process of treatment are evaluated. Inspection indicators, as well as the psychotherapists in accordance with the requirements of each psychotherapy summary records, through the two groups of specific quantitative data and psychotherapy records of the analysis, compared with the presentation of two psychotherapy processes, and quantitative analysis of the results of the treatment. Software SPSS18.0, independent sample t test, chi square test, Repeated measurement of variance analysis, logistic regression analysis.
Result:
1. the quantitative data analysis of psychodynamic therapy showed that the difference between the total score and the factor score of the SCL-90 scale was statistically significant (total score F=27.888, somatization F=24.101, forced F=9.826, interpersonal F=8.502, depression F=11.412, anxiety F=18.727, hostile F=9.278, terror F=16.453, paranoid F=4.487, F=4.904; P0.05); -74 total score, body function dimension and psychological function dimension were statistically significant between the two treatments (total score F=11.381, P=0.001; body dimension F=13.667, psychological dimension F=11.783; P0.05).SCL-90 subtraction rate analysis showed at the end of treatment, three months after the end of the end, and six months after the end of the psychotherapy group and drug treatment. The number of recovery + significant improvement in the group was more than that of the simple drug treatment group (x 2=6.372,8.336,11.577; P0.05). The logistic regression analysis of the factors affecting the effect of treatment showed that the variables of the final entry equation were the experimental group, the baseline GQOLI-74 scale psychological dimension score, and the baseline SSRS subjective support score.
2. through the text analysis of the psychodynamic therapy process, we know the basic process of treatment and the treatment plan. It is found that the subjective evaluation of the visitors in the course of treatment has fluctuated in addition to the "defense and impedance", which is basically maintained at "3" (slightly progressed) and above the level of water, and may have a predictive effect on the maintenance of the therapeutic effect.
3. the quantitative data analysis of cognitive therapy showed that the total score of SCL-90 (F=5.294, P=0.024), interpersonal sensitivity (F=4.396, P=0.039), depression (F=5.715, P=0.019), anxiety (F=4.659, P=0.034), terror (F=7.404, P=0.008), and psychotic (F=8.651, and P=0.008) were statistically significant in the two treatments, and two groups in different time points and each The factors have different.GQOLI-74 total score (F=19.479, P=0.000), body function dimension (P=11.988, T=0.001), and the social function dimension (F=26.326, P=0.000) have statistical significance in the difference between the two treatments, and the two groups include the psychological function dimension, and the above scores are different at different time points at different time points and different processing parties at different time points. The difference (F=11.337, P=0.000).SCL-90 reduction rate analysis showed that the recovery + significant improvement after the end of the treatment was more than that of the drug treatment group (x 2=6.873, P0.05). The logistic regression analysis of the factors affecting the improvement of the therapeutic effect showed that the variables of the entry path were the experimental group, the baseline GQOLI-74 scale heart. Physical dimension, baseline SCSQ positive coping style score.
4. through the text analysis of the cognitive treatment process, we know the basic process of treatment and the treatment technology. It is found that the subjective evaluation of the visitors is fluctuating in the process of "negative automatic thinking". The rest of the time is basically stable in "3" (slightly progressed) and above, and may have a predictive effect on the maintenance of the therapeutic effect.
1. quantitative data analysis showed that two psychotherapy combined with drug therapy had more significant efficacy compared with simple drug therapy, and the efficacy could be maintained within 6 months.
2. in addition to receiving psychotherapy, the factors affecting the effect of psychodynamic therapy included the baseline GQOLI-74 psychological dimension and the SSRS score. The factors affecting the effect in the cognitive therapy group were the baseline GQOLI-74 psychological dimension and the SCSQ positive coping style score.
3. in the process of psychodynamic therapy, when the visitors fully exploit their own ability and resources to meet their emotional needs, their physical and psychological symptoms will be improved, while the improvement of cognitive therapy symptoms occurs when the visitors learn to recognize and correct the middle beliefs and core beliefs, and strengthen the training of new cognitive patterns.
4. the two kinds of psychotherapy are different in the length of the treatment, the structure of the treatment, and the role of the therapist, but the two treatments are the same as the visitor, and the positive subjective evaluation and the good treatment relationship can contribute to the effect of the treatment.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749

【参考文献】