本文關(guān)鍵詞： 抑郁癥 計(jì)算機(jī)化心理治療 機(jī)制 元分析 潛在剖面分析 潛變量增長(zhǎng)曲線模型　出處：《華中師范大學(xué)》2012年博士論文　論文類型：學(xué)位論文

【摘要】：抑郁癥患者未接受治療通常帶來(lái)慢性、周期性及消極影響,包括家庭及社會(huì)功能不良、軀體疾病、自殺意圖和自殺行為等(McGorry, Purcell, Hickie,Jorm,2007; Merry, McDowell, Wild, et al.,2004).除了藥物治療與傳統(tǒng)心理治療,伴隨著計(jì)算機(jī)科學(xué)的發(fā)展,越來(lái)越多研究者對(duì)抑郁癥采用計(jì)算機(jī)化治療的新模式加以探索,使得這個(gè)領(lǐng)域成為當(dāng)前西方心理治療研究領(lǐng)域的一個(gè)前沿和熱點(diǎn)。 本研究回顧了國(guó)內(nèi)外抑郁癥的病理學(xué)理論及治療相關(guān)實(shí)證研究,接納與承諾療法(Acceptance and Commitment Therapy, ACT)和計(jì)算機(jī)化心理治療。然后,采用元分析系統(tǒng)考察了抑郁癥計(jì)算機(jī)化治療的效果及影響因素；研發(fā)了基于ACT的計(jì)算機(jī)化治療系統(tǒng),并考察了對(duì)抑郁癥的治療效果及適用當(dāng)事人的潛在類別最優(yōu)匹配；用潛變量增長(zhǎng)曲線模型(Latent growth curve modeling, LGM)考察基于ACT計(jì)算機(jī)化抑郁癥治療的作用機(jī)制。本研究的主體內(nèi)容分為三部分。 第一部分采用元分析與元回歸分析技術(shù),考察了抑郁癥計(jì)算機(jī)化治療的有效性及影響因素。來(lái)源于32篇文獻(xiàn),30項(xiàng)RCT研究的40個(gè)獨(dú)立樣本滿足了元分析標(biāo)準(zhǔn)(N=4795)。研究結(jié)果表明：(1)抑郁癥計(jì)算機(jī)化治療是有效的。其整體效果接近于中等效果量,在青少年群體中效果量較小,而成人群體效果量較大,達(dá)到中等效果量；3個(gè)月追蹤效果量為0.2,6個(gè)月追蹤效果量為0.15。(2)亞組分析發(fā)現(xiàn),所有亞組自我報(bào)告抑郁水平的后測(cè)值都有顯著下降,但聚合效果量有差異。在抑郁嚴(yán)重程度、招募設(shè)置、支持方式和測(cè)量量表四個(gè)亞組分析中,效果量存在顯著差異。在重癥抑郁、社區(qū)樣本、Email支持和采用其他測(cè)量量表的亞組中,其效果量顯著高于其他分類組。出版年份、脫落率和干預(yù)單元數(shù)對(duì)治療效果量有一定影響,但這些變量之間可能存在著交互作用,得出的結(jié)論需要謹(jǐn)慎對(duì)待。(3)研究可能存在出版偏差,但很難推翻現(xiàn)有結(jié)論。 第二部分研發(fā)了基于ACT的計(jì)算機(jī)化治療系統(tǒng),并考察了對(duì)抑郁癥的治療效果及適用當(dāng)事人的潛在類別最優(yōu)匹配。采用校園廣告招募的方式,通過(guò)施測(cè)BDI量表進(jìn)行入組篩選,招募自評(píng)抑郁患者182名,采用隨機(jī)對(duì)照組實(shí)驗(yàn)(治療組95人；等待組87人),自助治療組完成6單元的自助治療,每周一單元,追蹤3個(gè)月后自助治療效果。研究結(jié)果表明：(1)基于ACT的計(jì)算機(jī)化治療可以有效降低抑郁。與等待組相比較,ACT自助治療組后測(cè)抑郁下降水平顯著高于等待組,具有大效果量(d=1.27),3個(gè)月后的追蹤調(diào)查仍然存在中等效果量(d=0.75)。(2)基于ACT的計(jì)算機(jī)化治療還可以提升當(dāng)事人的積極心理健康水平。與等待組相比較,ACT自助治療組后測(cè)積極心理健康水平提升顯著高于等待組,具有中等效果量(d=0.59),3個(gè)月追蹤整體積極心理健康水平差異不顯著,但情緒幸福感(d=0.55)和心理幸福感(d=0.54)仍具有中等效果量。(3)潛在剖面分析顯示,基線抑郁、外傾性、內(nèi)傾性、阻抗特質(zhì)、性格、生物、童年和關(guān)系等8個(gè)當(dāng)事人特征可以分為3個(gè)潛在類別,分別為高心理反應(yīng)組(47%)、低心理反應(yīng)組(37%)和內(nèi)源性抑郁傾向組(16%)。(4)臨床意義上的改變分析顯示,高心理反應(yīng)組治愈率最高,內(nèi)源性抑郁傾向組治愈率最低,低心理反應(yīng)組的可靠改變但未痊愈率最高,三組在無(wú)可靠改變率上無(wú)顯著差異,這一結(jié)果在3個(gè)月后的追蹤測(cè)量中仍保持一致。 第三部分用LGM考察基于ACT計(jì)算機(jī)化抑郁癥治療的作用機(jī)制,主要分析了體驗(yàn)接納與認(rèn)知改變的中介效應(yīng)。采用校園招募自評(píng)抑郁患者124名,采用隨機(jī)對(duì)照組實(shí)驗(yàn)(治療組63人；等待組61人),自助治療組完成6單元的自助治療。研究結(jié)果表明,(1)接受與行動(dòng)、認(rèn)知離解和功能失調(diào)態(tài)度在基于ACT的抑郁癥計(jì)算機(jī)化治療過(guò)程中都發(fā)生顯著改變,自動(dòng)化思維的改變不顯著。體驗(yàn)回避在抑郁癥ACT計(jì)算機(jī)化治療中的中介效應(yīng)顯著,而認(rèn)知改變的中介效應(yīng)部分顯著。(2)接受與行動(dòng)、回避與融合、認(rèn)知離解和功能失調(diào)態(tài)度,在治療與抑郁癥狀改變之間的中介效應(yīng)顯著,也就是說(shuō),ACT計(jì)算機(jī)化治療的作用機(jī)制在于接受與行動(dòng)、回避與融合、認(rèn)知離解和功能失調(diào)態(tài)度的改變,從而影響抑郁水平改變。(3)接受與行動(dòng)、回避與融合和功能失調(diào)態(tài)度,在治療與積極心理健康提升之間的中介效應(yīng)顯著,即ACT計(jì)算機(jī)化治療的作用機(jī)制在于接受與行動(dòng)、回避與融合和功能失調(diào)態(tài)度的改變,從而影響積極心理健康水平改變。 綜合討論部分強(qiáng)調(diào),在技術(shù)上應(yīng)增加程序設(shè)計(jì)的互動(dòng)性與智能性,加強(qiáng)個(gè)性化治療,繼續(xù)考察在其他人群的治療效果,進(jìn)一步探討ACT計(jì)算機(jī)化抑郁癥治療的作用機(jī)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.

【學(xué)位授予單位】：華中師范大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2012
【分類號(hào)】：R749.4

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