本文選題：團體電腦游戲版豁達治療 + 肺癌��； 參考：《廣東藥科大學(xué)》2017年碩士論文

【摘要】：背景:全球每年約有820萬人死于癌癥,肺癌約占全部癌癥死亡的27.07%,是癌癥死亡的首要原因,我國肺癌發(fā)病率和死亡率均居癌癥之首。肺癌的治療方式一直是國內(nèi)外研究的熱點,目前肺癌的主要治療包括手術(shù)治療、藥物化學(xué)治療、放射治療、靶向治療及聯(lián)合治療等,但肺癌仍然是全球范圍內(nèi)的難治性疾病。肺癌患者在經(jīng)歷各種治療方式對身體削弱的同時,心理上也承受著巨大的折磨,出現(xiàn)不同程度的心理應(yīng)激,有研究顯示肺癌患者普遍存在焦慮、抑郁、失落等負性情緒。因此,研究適用于肺癌患者的心理干預(yù)方式以提高臨床療效和肺癌患者生存質(zhì)量顯得尤為重要。前期臨床研究顯示,團體電腦豁達治療應(yīng)用于乳腺癌患者,能夠顯著改善乳腺癌患者的應(yīng)對方式和心理調(diào)節(jié),為團體電腦游戲版豁達治療對肺癌患者的康復(fù)作用的研究奠定了堅實的基礎(chǔ)。目的:對肺癌住院患者進行團體電腦游戲版豁達治療,并從心理狀態(tài)、社會功能、潛意識、生理、免疫功能等多個維度對干預(yù)效果進行評價,為肺癌住院患者的心理、生理及社會康復(fù)提供理論與方法的實證資料。方法:1、匯同前期研究成果,制作完成改良團體電腦游戲版豁達治療(Collective Computer Game-version Magnanimous Therapy,CCGMT)軟件,在原有的電腦豁達治療的基礎(chǔ)上引入團體治療和游戲治療的形式,以豐富生動的游戲為載體增加治療的趣味性、互動性,提高患者的依從性,以團體治療的模式提高治療效率、強化療效,為患者提供社會支持和情感寄托、提升社會功能。2、對符合入組標準的72例肺癌住院患者按照匹配分組原則,分為CCGMT組36人和對照組36人。在常規(guī)肺癌治療的基礎(chǔ)上,將CCGMT組分為3-4人的團體治療小組,給予團體電腦游戲版豁達治療2周,每周4次,每次約40分鐘;對照組僅按照常規(guī)肺癌臨床治療,不給予心理治療。所有患者均在治療前及2周后均通過癌癥患者心身狀態(tài)量表(Psychosomatic Statue Scale for Canner Patients,PSSCP)、T型心理量表(Tumour Psychological Scale,TPS)、癌癥患者心理調(diào)節(jié)量表(Psychological Adjustment Scale for Cancer Patients,PASCP)、癌癥應(yīng)對問卷(Cancer Coping Modes Questionnaire,CCMQ)、進取豁達問卷(Enterprising and Magnanimous Questionnaire,EMQ)、癌癥病人生活功能指標量表(Functional Living Index-Cancer,FLIC)、醫(yī)院焦慮抑郁量表(Hospital Anxiety Depression,HAD)和潛意識繪畫房-樹-人測驗,進行心理及社會功能的評價;采用生物反饋儀記錄呼吸、心率、血壓、腦電波值,靜脈采血檢查免疫細胞Ig A、Ig G、Ig M、NK值評價患者的生理指標。結(jié)果:1.完成改良版團體電腦游戲版豁達治療(CCGMT)軟件的制作。2.心理、社會指標結(jié)果(1)PSSCP評分:心理干預(yù)2周后,CCGMT組在“總分”、“心理”維度、“軀體”維度評分、“社會功能”維度、“心理行為可塑性”維度的評分均較入院時降低,差異有統(tǒng)計學(xué)意義(p0.05);對照組2周后“總分”、“軀體”維度評分、“心理可塑性”維度評分較入院時增高,差異有統(tǒng)計學(xué)意義(p0.05),“心理”維度、“社會功能”維度評分與入院時的差異無統(tǒng)計學(xué)意義(p0.05)。組間比較顯示,CCGMT組與對照組2周前后的差值在“總分”、“心理”維度、“軀體”維度評分、“社會功能”維度、“心理行為可塑性”維度的差異均有統(tǒng)計學(xué)意義(p0.05).(2)TPS評分:兩組2周后在總均分、“個性特點”維度、“認知習(xí)慣”維度、“情緒表現(xiàn)”維度和“潛意識”維度的評分與入院時相比,差異均無顯著性(p0.05)。(3)PASCP評分:CCGMT組干預(yù)2周后總均分、“情緒/自尊”維度、“主觀感覺”維度、“人際關(guān)系/社會生活”維度、“日常生活”維度和“其他”維度評分均高于入院時,差異有顯著性(p0.05);對照組2周后總均分、“情緒/自尊”維度、“主觀感覺”維度、“人際關(guān)系/社會生活”維度、“日常生活”維度和“其他”維度與入院時相比,均差異無顯著性(p0.05)。組間比較顯示,CCGMT組與對照組2周前后在的差值在“主觀感覺”維度、“人際關(guān)系/社會生活”維度均有統(tǒng)計學(xué)意義(p0.05);兩組2周前后差值在“總均分”、“情緒/自尊”維度、“日常生活”維度和“其他”維度無顯著性差異(p0.05)。(4)CCMQ評分:CCGMT組在干預(yù)2周后的“面對”維度高于入院時,干預(yù)2周后“回避與壓抑”和“屈服”維度低于入院時,差異有顯著性(p0.05);而在“總均分”、“幻想”和“發(fā)泄”維度2周前后無顯著性差異(p0.05);對照組2周后“總均分”、“面對”維度、“回避與壓抑”維度、“屈服”維度、“幻想”維度、“發(fā)泄”維度與入院時相比,差異無統(tǒng)計學(xué)意義(p0.05)。組間比較結(jié)果為,CCGMT組與對照組2周前后在的差值在“面對”維度、“屈服”維度均有統(tǒng)計學(xué)意義(p0.01);兩組2周前后差值在“回避與壓抑”維度差異無顯著性(p0.05)。(5)EMQ評分:CCGMT組干預(yù)2周后“積極進取”維度高于入院時(35.03±4.55),差異有統(tǒng)計學(xué)意義(p0.05);而在“總分”、“豁達寬容”維度與2周前相比,無顯著性差異(p0.05);對照組2周后“總分”、“積極進取”維度、“豁達寬容”維度與入院時相比,差異均無顯著性(p0.05)。組間比較顯示,在“積極進取”維度CCGMT組與對照組2周前后差值的差異有統(tǒng)計學(xué)意義(p0.05)。(6)FLIC評分:CCGMT組干預(yù)2周后“總均分”、“軀體良好和能力”維度、“心理良好”維度、“社會良好”維度高于入院時,“因癌造成的艱難”維度低于入院時,差異有統(tǒng)計學(xué)意義(p0.05),而“惡心”維度在2周后較入院時降低,但差異無顯著性(p0.05);對照組2周后“總均分”、“軀體良好和能力”維度、“心理良好”維度、“社會良好”維度低于入院時,“因癌造成的艱難”、“惡心”維度高于入院時,但差異無統(tǒng)計學(xué)意義(p0.05)。CCGMT組與對照組入院時在“總均分”、“軀體良好和能力”維度、“心理良好”維度、“因癌造成的艱難”、“社會良好”維度評分差異均無統(tǒng)計學(xué)意義(p0.05);組間比較顯示,CCGMT組與對照組2周前后的差值在“軀體良好和能力”維度、“心理良好”維度、“社會良好”維度的差異均有統(tǒng)計學(xué)意義(p0.05).(7)HAD評分:CCGMT組干預(yù)2周后總分、焦慮評分、抑郁評分低于入院時,且具有顯著性差異(p0.01);對照組2周后總分、焦慮評分、抑郁評分較入院時無顯著性差異(p0.05)。CCGMT組與對照組入院時在總分、焦慮評分、抑郁評分差異均無統(tǒng)計學(xué)意義(p0.05);2周后兩組在總分、焦慮評分、抑郁評分均有顯著性差異(p0.01)。CCGMT組與對照組2周前后的差值在總分、焦慮評分、抑郁評分有顯著性差異(p0.01).(8)房-樹-人投射測驗:CCGMT組經(jīng)過2周的心理治療后較入院時,畫面內(nèi)容更為豐富,房、樹、人形態(tài)更飽滿、更有生命力,畫面整體的比例更協(xié)調(diào),筆觸流暢、清晰,無反復(fù)涂擦痕跡,斷枝、將人或樹涂黑、樹干創(chuàng)傷、房屋缺損等消極投射點減少,房屋完整、樹葉繁茂、人物帶笑等積極投射點較多;對照組2周后,房-樹-人繪畫各部分內(nèi)容仍為簡單羅列,無附加物、無遠近感,整體畫面布局不協(xié)調(diào),筆觸猶豫、斷續(xù),有多處涂改痕跡,積極投射點較少,人物呆立、肢體不全等消極投射點較前增多。3.生理指標結(jié)果(1)CCGMT組干預(yù)2周后,收縮壓值、心率值較入院時有所下降,差異具有顯著性(p0.05),舒張壓、呼吸數(shù)值2周前后差異無統(tǒng)計學(xué)意義(p0.05);對照組2周后,收縮壓值、舒張壓、心率和呼吸數(shù)值較入院時均無顯著性差異(p0.05)。組間比較顯示,CCGMT組與對照組2周前后心率的差值有顯著性差異(p0.05)。(2)在干預(yù)2周后,CCGMT組皮電和θ波值較入院時降低,差異均具有顯著性(p0.01);皮溫、α波、β波、SMR波值較2周前降低,但差異無統(tǒng)計學(xué)意義(p0.05)。對照組2周后,β波、θ波值較前下降,皮電、皮溫、α波和SMR波值較入院時升高,但差異均無統(tǒng)計學(xué)意義(p0.05)。組間比較顯示,CCGMT組與對照組2周前后皮電、θ波數(shù)值的差值有顯著性差異(p0.01)。(3)免疫球蛋白三項及NK細胞值比較:在進行團體電腦游戲版豁達治療2周后,CCGMT組Ig A和NK細胞值較入院時升高,且差異具有顯著性(p0.05),Ig G和Ig M值在2周前后差異無統(tǒng)計學(xué)意義(p0.05);對照組在常規(guī)肺癌治療2周后,Ig G和NK細胞值較入院時降低,且差異有統(tǒng)計學(xué)意義(p0.05)。組間比較顯示,CCGMT組與對照組2周后在的差值在Ig A和NK細胞值有統(tǒng)計學(xué)意義(p0.05)。4.臨床定性評價團體電腦游戲版豁達治療結(jié)合電腦豁達治療、團體治療和游戲心理治療的優(yōu)勢,得到了臨床肺癌患者的一致肯定,認為其生動有趣、簡單易行、交互性強、富含哲理,能有效幫助患者改善不良情緒、調(diào)整應(yīng)對方式、提高心理調(diào)節(jié)能力,使患者在心身得到愉悅的同時促進了患者與患者之間、醫(yī)生與患者之間的關(guān)系良好發(fā)展,形成和諧的治療氛圍,為患者提供社會支持、改善社會功能,提高臨床抗腫瘤治療效果和肺癌患者的生存質(zhì)量,得到了廣泛認可。結(jié)論:團體電腦游戲版豁達治療對肺癌住院患者的心身狀態(tài)、社會功能及生存質(zhì)量均有積極的作用。本治療通過簡單有趣、貼近生活、交互性強的電腦游戲的方式,將積極樂觀、理解接受、平衡包容、平靜愉悅、放曠自如的人生態(tài)度滲透到每一次治療中,幫助患者調(diào)節(jié)緊張、焦慮、悲觀、抑郁等負性情緒,改善患者心理調(diào)節(jié)能力和心理應(yīng)對能力,并對血壓、心率、皮電、腦電波、Ig A及NK細胞值能生理指標都有明顯的改善。通過房-樹-人投射測驗可以觀察到,在接受治療后肺癌患者的潛意識出現(xiàn)一定程度的良性變化。肺癌患者普遍認為接受治療能使心身愉悅,明顯提高生活質(zhì)量,改善醫(yī)生與患者、患者與患者之間的關(guān)系,提高臨床抗腫瘤治療的積極性和療效。團體電腦游戲版豁達治療作為一種有效的心理治療方式,有利于臨床肺癌患者心理、生理、社會功能、臨床療效及生存質(zhì)量的改善,為臨床腫瘤的綜合治療提供了實證依據(jù)。
[Abstract]:Background: about 8 million 200 thousand people die from cancer every year around the world. Lung cancer accounts for about 27.07% of all cancer deaths. It is the leading cause of cancer death. The incidence and mortality of lung cancer in China are the first. The treatment of lung cancer has always been a hot spot at home and abroad. The main treatment of lung cancer includes surgical treatment, chemical therapy, radiation treatment. Treatment, targeted therapy and combined therapy, but lung cancer is still a global refractory disease. Lung cancer patients suffer from a variety of treatment methods to weaken the body, while the psychological also bear a huge torment, there are different degrees of psychological stress, there is a research show that the lung cancer patients generally have anxiety, depression, loss and other negative emotions. Therefore, it is very important to study the psychological intervention for patients with lung cancer in order to improve the clinical effect and the quality of life of the patients with lung cancer. The earlier clinical study showed that the application of group computer immunity to breast cancer patients could significantly improve the coping style and psychological adjustment of the breast cancer patients, and the group computer game version was treated with open-minded therapy. The study of the rehabilitation of lung cancer patients has laid a solid foundation. Objective: to carry out the group computer game therapy of lung cancer patients and evaluate the intervention effect from the psychological state, social function, subconscious, physiological and immune function, and provide the theory of psychological, physiological and social rehabilitation for the hospitalized patients with lung cancer. Methods: 1, 1, remittance with the previous research results, the completion of the improved group computer game version of open-minded therapy (Collective Computer Game-version Magnanimous Therapy, CCGMT) software, based on the original computer open-minded treatment based on the introduction of group therapy and game therapy in the form of rich and vivid games for the carrier. With the interest, interaction, improvement of patient compliance, group treatment to improve the efficiency of treatment, strengthen the curative effect, provide social support and emotional support for the patients, improve the social function.2, 72 cases of lung cancer patients who conform to the standard of the group are divided into 36 group and 36 control group according to the matching division principle, in the routine lung. On the basis of cancer treatment, group CCGMT was divided into group treatment group of 3-4 people, which was given group computer game version of open-minded therapy for 2 weeks, 4 times a week, about 40 minutes each time. The control group was only treated with conventional lung cancer, and no psychotherapy was given. All patients passed the heart and body state scale (Psychosomatic Sta) before and after 2 weeks. Tue Scale for Canner Patients, PSSCP), T type psychological scale (Tumour Psychological Scale, TPS), cancer patient psychological adjustment scale, cancer coping questionnaire, enterprising and open-minded questionnaire Functional Living Index-Cancer (FLIC), the hospital anxiety and Depression Scale (Hospital Anxiety Depression, HAD) and the subconscious painting room tree man test, the evaluation of psychological and social functions, and the biological feedback instrument to record the respiratory, heart rate, blood pressure, brain wave value, and venous blood sampling to check the immune cell Ig. A, Ig G, Ig M, NK value to evaluate the physiological indicators of patients. Results: 1. complete the improved version of the group computer game version of open-minded therapy (CCGMT) software for the production of.2. psychology, social indicators (1) PSSCP score: after 2 weeks of psychological intervention, the CCGMT group in the "total score", "psychological" dimension, "body" dimension score, "social function" dimension, "psychological behavior can be" The score of plastic dimension was lower than that of admission, and the difference was statistically significant (P0.05). After 2 weeks, the score of "total score", "body" dimension, and "psychological plasticity" score were higher than that of admission. The difference was statistically significant (P0.05). The "psychological" dimension, "social function" dimension score and the difference of admission were not statistically significant. Meaning (P0.05). The difference between group CCGMT and control group showed that the difference between 2 weeks before and after the control group was in "total score", "psychological" dimension, "body" dimension score, "social function" dimension, "psychological behavior plasticity" dimension difference were statistically significant (P0.05). (2) TPS score: two groups after 2 weeks in the total average, "personality characteristics" dimension, "recognition". The score of knowledge and habit dimension, emotional expression dimension and subconscious dimension were not significant compared with admission (P0.05). (3) PASCP score: the total score of group CCGMT after 2 weeks, "emotion / self-esteem" dimension, "subjective sense" dimension, "interpersonal relationship / social life" dimension, "daily life" dimension and "other" The difference was significantly higher than that of admission (P0.05); the total average score of the control group 2 weeks later, "emotion / self-esteem", "subjective sense", "interpersonal relationship / social life", "daily life" and "other" dimensions were not significantly different from that of admission (P0.05). The comparison between groups showed that the CCGMT group and the pair were the same. The difference between the 2 weeks before and after 2 weeks in the "subjective sense" dimension, "interpersonal relationship / social life" dimension had statistical significance (P0.05); the difference between the two groups and the 2 weeks before and after the "total average", "emotion / self-esteem" dimension, "daily life" dimension and "other" dimension no significant difference (P0.05). (4) CCMQ score: group CCGMT after 2 weeks of intervention When the "face" dimension was higher than that of admission, after 2 weeks of intervention, the dimension of "avoidance and depression" and "yield" dimension were significantly lower than that of admission (P0.05), while there was no significant difference between the "total average", "fantasy" and "venting" dimensions before and after 2 weeks (P0.05); the control group was "total equal", "face" dimension, "avoidance and depression" after 2 weeks. There was no significant difference in dimension, "yield" dimension, "fantasy" dimension, and "vent" dimension compared with admission (P0.05). The results of comparison between group CCGMT and control group were statistically significant (P0.01) in "face" dimension, and the difference between the two groups and 2 weeks before and after 2 weeks was in the dimension of "avoidance and depression". There was no significant difference (P0.05). (5) EMQ score: the dimension of "positive and enterprising" in group CCGMT was higher than that of admission (35.03 + 4.55) after 2 weeks of intervention (P0.05), but there was no significant difference between the "total score" and the "open-minded tolerance" dimension compared with 2 weeks before (P0.05); the control group was "total score", "positive enterprising" dimension, "Huo Dakuan" after 2 weeks. The difference was not significant (P0.05). The difference between the "aggressive" dimension CCGMT group and the control group was statistically significant (P0.05). (6) the FLIC score: the CCGMT group intervened 2 weeks after 2 weeks, "the body good and the ability" dimension, the "good psychological" dimension, "the social good". "Good" dimension is higher than admission, "the difficulty caused by cancer" dimension is lower than admission, the difference is statistically significant (P0.05), but the "nausea" dimension after 2 weeks is lower than the admission, but the difference is not significant (P0.05); the control group after 2 weeks "total equal", "body good and ability" dimension, "good psychological" dimension, "good society" When the dimensions were lower than the admission, the "nausea" dimension was higher than that of admission, but the difference was not statistically significant (P0.05) in the.CCGMT group and the control group, the scores of "total equality", "good body and ability", "good psychological" dimension, "hardship made by cancer", and "good social" dimension score were all indifferent. Study significance (P0.05); the difference between group CCGMT and control group showed that there were significant differences in "good body and ability" dimension, "good psychological" dimension and "good social" dimension (P0.05). (7) HAD score: the total score, anxiety score, and depression score of group CCGMT were lower than that of admission, and the score of depression was lower than that of admission, and it was significant and significant. There was no significant difference in total score, anxiety score and depression score in the control group after 2 weeks (P0.05). There was no significant difference between the.CCGMT group and the control group at the total score, the anxiety score and the depression score (P0.05) in the.CCGMT group and the control group (P0.05); the two groups in the total score, the anxiety score and the depression score were significantly different (P0.01).CCGMT and the control group after the admission. The difference between the 2 weeks before and after the total score, the anxiety score and the depression score had significant difference (P0.01). (8) the room tree man projection test: after 2 weeks of psychological treatment, the CCGMT group was more rich in the content of the picture, the room, the tree, the human form were more full, more vitality, the proportion of the whole painting was more coordinated, the strokes were fluent, clear, and no repeated smear marks, After 2 weeks of the control group, the contents of the house - tree - man painting are still simple, no appendages, no distant sense, uncoordinated layout of the whole picture, hesitancy of strokes, intermittent, and multiple marks. The negative projection points were less than those of the previous increase of.3. physiological indexes (1) after the intervention of CCGMT group, the systolic pressure and heart rate decreased after 2 weeks, and the difference was significant (P0.05), diastolic pressure and respiratory value before and after 2 weeks (P0.05), and the contractile pressure of the control group after 2 weeks, the systolic pressure value, There was no significant difference in diastolic pressure, heart rate and respiratory value (P0.05). The difference between group CCGMT and control group was significant (P0.05). (2) after 2 weeks of intervention, the values of skin and theta in CCGMT group were lower than those at admission (P0.01), and the values of skin temperature, alpha, beta, SMR wave were lower than that of 2 weeks. Low, but the difference was not statistically significant (P0.05). After 2 weeks in the control group, the values of beta wave and theta wave were lower than before, and the values of skin electricity, skin temperature, alpha and SMR were higher than those at admission, but the difference was not statistically significant (P0.05). The difference between group CCGMT and the control group was significant (P0.01). (3) three items of immunoglobulin (3) three items of immunoglobulin. Compared with NK cell value: after 2 weeks of group computer game, the value of Ig A and NK cells in group CCGMT was higher than that of admission, and the difference was significant (P0.05). There was no statistical difference between Ig G and Ig M values before and after 2 weeks (P0.05). Study significance (P0.05). The difference between group CCGMT and control group showed that the difference between 2 weeks and the control group was statistically significant at Ig A and NK cell values (P0.05).4. clinical qualitative evaluation group computer game version of open-minded therapy combined with computer immunity, group therapy and game psychotherapy, and got the consistent affirmation of the clinical lung cancer patients. Lively and interesting, simple and easy to interact, rich in philosophy, can effectively help the patient to improve the bad mood, adjust the coping style, improve the psychological adjustment ability, make the patient in the heart and body pleasing, and promote the patient and patient, the good development of Guan Xiliang between the doctor and the patient, form a harmonious treatment atmosphere and provide the society for the patient. Support, improve social function, improve the effect of clinical antitumor treatment and the quality of life of lung cancer patients, it has been widely recognized. Conclusion: the group computer game version of open-minded therapy has a positive effect on the psychosomatic state, social function and quality of life of the patients with lung cancer. The way of brain games will be positive and optimistic, understanding acceptance, balance and tolerance, calm and pleasing, and an open and happy life attitude permeating every treatment, helping patients adjust the negative emotions such as tension, anxiety, pessimism, depression, and improve the patient's psychological adjustment and psychological coping ability, and the blood pressure, heart rate, skin electricity, brain wave, Ig A and NK cell values. There is a significant improvement in the physiological index. Through the house tree man projection test, it is observed that the subconsciousness of the lung cancer patients has a certain degree of benign change after the treatment. The lung cancer patients generally believe that the treatment can make the heart and body happy, improve the quality of life obviously, improve the relationship between the medical students and the patients, the relationship between the patients and the patients, and the improvement of the relationship between the patients and the patients. The initiative and efficacy of clinical antitumor therapy is an effective way of psychotherapy.
【學(xué)位授予單位】：廣東藥科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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