【摘要】：研究背景“三才”指個體的生存環(huán)境,中醫(yī)心理學(xué)的“三才整體論”強調(diào)個體所處的社會環(huán)境對其心理健康的影響,并認為很多的情志疾病都與患者所處環(huán)境有關(guān)。抑郁癥是一種以心境低落為主要特征的精神心理疾病,屬于中醫(yī)“郁病”范疇,終身患病風險率達17-19%,嚴重影響到患者及家屬的生活、工作,世界衛(wèi)生組織預(yù)測,到2020年,抑郁癥將成為全球第二大疾病負擔。己有研究顯示抑郁癥發(fā)病過程中環(huán)境造成的應(yīng)激因素發(fā)揮了非常重要的作用,而對個體產(chǎn)生影響的各種事件成為生活經(jīng)歷存儲在其記憶中,因此針對記憶的診療方法在抑郁癥的心理診療方面具有重要意義。中醫(yī)心理憶溯性方法,就是通過記憶回溯進行中醫(yī)心理研究與治療的方法。中醫(yī)心理低阻抗意念導(dǎo)入療法(TIP)、提綱式作業(yè)、憶溯性人格發(fā)展量表(WMPI)等都是基于憶溯性方法創(chuàng)立的治療或評估方法。TIP是通過氣功入靜方式將患者導(dǎo)入低阻抗狀態(tài)中,進行意念導(dǎo)入,重點對患者以往經(jīng)歷進行治療的中醫(yī)心理治療方法;提綱式作業(yè)是要求患者按照提綱回憶并書寫人生經(jīng)歷的病史資料收集方法;WMPI是根據(jù)被試的回憶評估各個年齡階段人格要素發(fā)展水平的心理測量工具;臨床上此三者在抑郁癥的診療中起到重要作用。前期研究發(fā)現(xiàn)基于憶溯性方法的中醫(yī)心理TIP療法對于抑郁癥有較好的臨床療效,但是關(guān)于TIP療法的對于抑郁癥的心理治療機制研究,目前依然是空白。目的明確基于憶溯性方法的中醫(yī)心理低阻抗意念導(dǎo)入療法(TIP)對于抑郁癥的治療效果,探索TIP療法對于抑郁癥的心理治療機制;并探討中醫(yī)心理憶溯性方法在抑郁癥臨床診療方面的意義。方法本研究以60例輕中度抑郁癥患者為研究對象,隨機分為研究組和對照組,研究組采用基于憶溯性方法的中醫(yī)心理低阻抗意念導(dǎo)入療法(ITP),對照組采用認知行為療法(CBT),對入組患者進行12周的心理治療。研究工具包括診斷工具DSM-ⅣV及半結(jié)構(gòu)定式訪談SCID,測評工具24項漢密爾頓抑郁量表(HAMD-24),漢密爾頓焦慮量表(HAMA),貝克抑郁評定量表(BDI),憶溯性人格發(fā)展量表(WMPI)。治療前、治療第4、8、12周以及治療結(jié)束后3個月,進行HAMD、HAMA、BDI檢查以明確心理治療對抑郁癥的治療效果;治療前以及治療第12周進行WMPI檢查,以研究心理治療對于抑郁癥人格要素的影響;治療前以及治療12周TIP組患者完成兩次提綱式作業(yè),通過提綱式作業(yè)的質(zhì)性分析研究患者對于TIP治療的主觀反應(yīng)及反饋。分析方法包括提綱式作業(yè)的質(zhì)性分析方法,以及使用SPSS22.0統(tǒng)計軟件進行病例基本情況、基線統(tǒng)計、療效指標的組內(nèi)組間比較分析等。結(jié)果1.治療有效率12周治療結(jié)束時兩組主要療效指標HAMD得分較治療前均有明顯下降(P0.01),根據(jù)有效率統(tǒng)計,TIP組總有效率為80%,CBT組總有效率為66.7%,TIP組有效率與CBT組有明顯差異(P0.05)。治療結(jié)束后3月隨訪時,兩組均未見服用抗抑郁藥物或接受治療患者,組內(nèi)比較兩組隨訪時HAMD得分與該組治療前均保持差異(P0.01),且TIP組隨訪時HAMD得分與該組治療后相比,有進一步下降(P0.05),組間比較TIP組隨訪時HAMD得分優(yōu)于CBT組(P0.01)。2.HAMD、HAMA以及BDI改善情況經(jīng)過治療,除CBT組在HAMD體重因子分及HAMA軀體焦慮因子分未見明顯變化以外,兩組在HAMD、HAMA、BDI總分以及各個因子分經(jīng)過治療都有明顯改善(P0.05)。治療4周時,在HAMA精神焦慮因子分以及總分TIP組與CBT組開始出現(xiàn)明顯差異(P0.05)。治療8周時,在HAMA軀體焦慮因子分,HAMD焦慮/軀體化因子分、日夜變化因子分,以及BDI總分,TIP組與CBT組開始出現(xiàn)明顯差異(P0.05)。第12周治療結(jié)束時,在HAMD遲緩因子分TIP組與CBT組開始出現(xiàn)明顯差異(P0.05)。治療后3月隨訪時,TIP組與CBT組在HAMD總分和認知障礙因子分出現(xiàn)明顯差異(P0.05)。以上差異均是TIP組得分優(yōu)于CBT組,且差異持續(xù)至隨訪。在HAMD睡眠障礙、絕望感和體重因子分方面兩組未出現(xiàn)明顯差異(P0.05)。3.WMPI異常人格要素數(shù)量變化治療后TIP組和CBT組在WMPI異常人格要素總數(shù)方面較治療前均有所減少(P0.05)。治療后TIP組異常人格要素總數(shù)少于CBT組(P0.05)。從年齡段角度分析,治療后TIP組在童年、少年、青年各時期異常人格數(shù)較治療前均有減少(P0.05),CBT組在青年期異常人格要素個數(shù)較治療前有所減少(P0.05),治療后TIP組在童年期和少年期異常人格要素數(shù)量方面較CBT組少(P0.05)。從人格要素角度統(tǒng)計,治療后TIP組在意志、教養(yǎng)方式、膽氣、自知、思慮方面異常人格要素數(shù)量較治療前有所減少(P0.05),CBT組治療前后未出現(xiàn)明顯差異(P0.05)。4.TIP組提綱式作業(yè)質(zhì)性分析結(jié)果(1)事件數(shù)量的變化提綱式作業(yè)的質(zhì)性分析發(fā)現(xiàn),在整體字數(shù)、事件數(shù)方面,治療后提綱式作業(yè)都較療前明顯減少(P0.05)。按年齡段分析,少年、青年、近期事件較療前有減少(P0.05),童年、成年期事件數(shù)量未見差異(P0.05)。按事件類型分析,療后負性的家庭、社會、學(xué)習工作以及個人事件較療前減少明顯(P0.05),負性教養(yǎng)事件和正性事件無差異(P0.05)。按伴隨情緒分析,療后伴隨怒、恐、悲、憂情緒的事件較療前減少明顯(P0.05),伴隨喜情緒的事件未見差異(P0.05)。(2)具體事件的變化同一事件在治療前后的提綱式作業(yè)中出現(xiàn)認知、伴隨的情緒表達方面的變化,包括伴隨情緒的更加平和與開放,認知方面包括對負性事件的接納,以及對現(xiàn)實問題更加多視角、理性、具體地思考與解決。(3)治療反饋在患者治療后提綱式作業(yè)中對于治療的反饋包含對于治療方法、收獲感悟以及癥狀改善三個方面的內(nèi)容�；颊咛峒暗氖斋@感悟包括對抑郁癥的認識,對于人生的認識,對負性事件、自身的缺點的接納,以及自我能力的提升等等;癥狀改善包括抑郁情緒、軀體癥狀、焦慮、自卑以及自罪的改善等。結(jié)論1、基于憶溯性方法的中醫(yī)心理低阻抗意念導(dǎo)入療法(TIP)對于輕中度抑郁癥有較好的治療效果,能夠降低漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)、貝克抑郁評定量表(BDI)總分以及各項因子分,有效改善抑郁癥狀,治療結(jié)束后有持續(xù)改善效果,效果較認知行為療法(CBT)更具優(yōu)勢,且隨訪時優(yōu)勢明顯。2、基于憶溯性方法的中醫(yī)心理低阻抗意念導(dǎo)入療法(TIP)對于輕中度抑郁癥人格素質(zhì)或易感性有改善作用,憶溯性人格發(fā)展量表(WMPI)顯示TIP療法可減少抑郁癥患者異常人格要素數(shù)量,提綱式作業(yè)顯示治療后患者對記憶中事件的情緒、認知等發(fā)生變化。3、基于憶溯性方法的中醫(yī)心理低阻抗意念導(dǎo)入療法(TIP)對于抑郁癥的心理治療機制是通過氣功入靜的方式,降低患者阻抗,深入患者元神與記憶,利用具象思維調(diào)動感知覺,運用憶溯性方法,針對患者記憶進行意念信息的導(dǎo)入,并且通過元神影響識神、欲神,改變患者抑郁情緒以及不良認知行為,改善抑郁癥的人格易感性,從而起到治療作用。各種技術(shù)包括放松誘導(dǎo)降低阻抗;通過憶溯性共情宣泄患者不良情緒;通過憶溯性病史分析使患者了解抑郁癥發(fā)病路線并配合治療;通過憶溯性再成長糾正人格要素的缺失和偏移;通過與憶溯性方法配合的行為治療以及對癥治療糾正不良行為激發(fā)良好行為,并且緩解抑郁癥的軀體癥狀。4、中醫(yī)心理憶溯性方法針對抑郁癥的心理病機,在中醫(yī)學(xué)三因制宜、治病求本的理論指導(dǎo)下,通過對患者記憶進行研究,探索發(fā)病路線及人格易感性,并且針對其過去經(jīng)歷進行憶溯性中醫(yī)心理治療,在抑郁癥的臨床診療中具有重要意義。
[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.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R277.7

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