团体正念认知疗法在抑郁症伴睡眠障碍患者中的应用效果

张惠玲; 钱超; 陈莹; 杨晓妍

doi:10.16766/j.cnki.issn.1674-4152.003385

团体正念认知疗法在抑郁症伴睡眠障碍患者中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003385

张惠玲^1, ,,
钱超¹,
陈莹²,
杨晓妍¹

1.
绍兴市第七人民医院焦虑障碍科，浙江绍兴 312000
2.
绍兴市第七人民医院精神障碍科

基金项目:

浙江省医药卫生科技计划项目 2019KY724

详细信息

通讯作者:
张惠玲，E-mail：Zhl176620842@163.com

中图分类号: R749.05
计量
- 文章访问数: 45
- HTML全文浏览量: 18
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-30
- 网络出版日期: 2024-03-27

Application effects of group mindfulness cognitive therapy in patients of depression with sleep disorders

1.
Department of Anxiety Disorder, Shaoxing Seventh People's Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析团体正念认知疗法对抑郁症伴睡眠障碍患者临床症状、睡眠质量及正念觉知能力的影响。方法选取2023年1—9月绍兴市第七人民医院收治的193例抑郁症伴睡眠障碍患者，根据随机数字表法将其分为对照组(96例)和观察组(97例)。对照组应用常规心理干预，观察组在对照组的基础上应用团体正念认知疗法。比较2组患者干预前后抑郁症状[抑郁自评量表(SDS)及汉密尔顿抑郁量表(HAMD)]、睡眠质量[阿森斯失眠量表(AIS)和失眠严重程度指数(ISI)]及正念觉知能力[五因素正念度量表(FFMQ)]。结果干预后，观察组患者SDS、HAMD、AIS、ISI得分分别为(51.20±3.64)分、(17.46±2.52)分、(11.05±2.33)分、(12.24±2.80)分，对照组分别为(55.64±4.71)分、(19.72±3.43)分、(14.11±3.14)分、(15.91±3.17)分，观察组均低于对照组(P < 0.05)。干预后，观察组患者FFMQ各维度得分及总分均明显高于对照组(P < 0.05)。结论团体正念认知疗法能明显缓解抑郁症伴睡眠障碍患者抑郁症状，提高患者睡眠质量及正念水平。
- 抑郁症 /
- 睡眠障碍 /
- 团体正念认知疗法 /
- 正念水平
Abstract: Objective To analyze the impacts of group mindfulness cognitive therapy on clinical symptoms, sleep quality, and mindfulness awareness in patients of depression with sleep disorders. Methods A total of 193 patients of depression with sleep disorders admitted to the Shaoxing Seventh People's Hospital from January 2023 to September 2023 were selected. They were divided into a control group (n=96) and an observation group (n=97) using the random number table method. The control group received routine psychological intervention, while the observation group received group mindfulness cognitive therapy based on the control group. The depressive symptoms [self rating depression scale (SDS) and Hamilton depression scale (HAMD)], sleep quality [Athens insomnia scale (AIS) and insomnia severity index (ISI)], and mindfulness level [five factor mindfulness questionaire (FFMQ)] were compared between the two groups of patients before and after intervention. Results After intervention, the observation group patients exhibited significantly lower scores in SDS (51.20±3.64), HAMD (17.46±2.52), AIS (11.05±2.33) and ISI (12.24±2.80), compared to the control group with scores of 55.64±4.71, 19.72±3.43, 14.11±3.14 and 15.91±3.17, respectively (P < 0.05). Furthermore, the FFMQ scores in all dimensions, total scores of the observation group were significantly higher than those of the control group (P < 0.05). Conclusion Group mindfulness cognitive therapy can significantly alleviate depressive symptoms in patients of depression with sleep disorders, and improve sleep quality and mindfulness level.
- Depression /
- Sleep disorders /
- Group mindfulness cognitive therapy /
- Mindfulness level

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表 1 2组抑郁症伴睡眠障碍患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with depression and sleep disorders

组别	例数	性别(例)		年龄(x±s，岁)	文化程度(例)			婚姻状况(例)			病程(x±s，年)	抑郁程度(例)
组别	例数	男性	女性	年龄(x±s，岁)	初中及以下	高中/中专	大专及以上	未婚	已婚	丧偶/离婚	病程(x±s，年)	轻度	中度
对照组	96	38	58	39.79±4.26	18	31	47	30	50	16	2.77±0.52	50	46
观察组	97	45	52	40.51±4.37	21	36	40	37	46	14	2.85±0.46	53	44
统计量		0.912^a		1.159^b	1.162^c			1.026^a			1.132^b	0.127^a
P值		0.339		0.248	0.559			0.599			0.259	0.722
注：^a为χ²值，^b为t值, ^c为Z值。

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表 2 团体正念认知治疗方案

Table 2. Group mindfulness cognitive therapy plan

频次	主题	干预内容
介绍会	建立治疗关系，认识正念疗法	(1)与患者建立治疗关系，患者间进行相互介绍，制定团体规则。(2)向患者介绍团体正念认知疗法目的、内容、时长及优点等，取得患者同意及配合。(3)向患者讲解抑郁症及睡眠障碍的病因、治疗和预后，帮助患者了解病情，纠正患者不良认知。
第1次	觉察当下	(1)向患者介绍正念七原则，对正念核心概念进行分享和讨论。(2)指导患者进行葡萄干禅和呼吸觉察练习，通过该练习让患者觉察当下，将觉察带入经验，从而改变经验。
第2次	觉察身体	(1)向患者讲述觉察和自动导航的意义，并引导患者间讨论他们是如何影响生活的。(2)指导患者进行正念呼吸训练与身体扫描练习，通过呼吸与身体扫描，帮助患者进行正念觉察身体，帮助患者了解压力源与压力感受之间的中介机制及交互机制作用及意义，将觉察带入日常生活中。
第3次	回到当下	(1)说明正念运动的优点，了解运动对大脑的影响，帮助患者感受到无论身在何处，尽量脱离额外的担忧和焦虑。(2)指导患者进行正念行走及正念活动禅训练，让患者在运动中带入对当下的觉知，有意识地感受不同身体活动带来的情绪感受，了解在正念运动中身体是如何运作的，体会身心合一、生命的美妙。
第4次	识别不良情绪	(1)帮助患者了解想法、情绪与身体的关系，帮助患者识别痛苦、抑郁、焦虑等不良情绪，弱化患者逃避情绪的习惯。(2)指导患者进行情绪冥想、正念静坐训练，鼓励患者关注此时此刻身心体验，并鼓励其改变自身想法、思维和身体感受之间的关系。
第5次	允许/顺其自然	(1)引导患者在感受到痛苦时，经由身体去体会，探讨自身想法仅仅为想法，并不是真实的自我，指导患者学习儒家思想与人际关系。(2)指导患者进行正念静坐及正念呼吸，在静坐与呼吸过程中讲述患者在遇到不良情绪及困难时，允许其发生。
第6次	智慧生活、展望未来	(1)指导患者学习正念心理疗法模型，将正念疗法常态化，融入日常生活中。(2)回顾往期课程，告知患者固定联系，成为正念人，展望未来美好生活。

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表 3 2组抑郁症伴睡眠障碍患者干预前后抑郁情绪比较(x±s，分)

Table 3. Comparison of depression before and after intervention in two groups of patients with depression and sleep disorders (x±s, points)

组别	例数	SDS		HAMD
组别	例数	干预前	干预后	干预前	干预后
对照组	96	60.75±5.83	55.64±4.71	21.02±3.11	19.72±3.43
观察组	97	60.91±5.42	51.20±3.64	20.89±3.24	17.46±2.52
t值		0.197	7.332	0.284	5.220
P值		0.844	< 0.001	0.776	< 0.001

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表 4 2组抑郁症伴睡眠障碍患者干预前后睡眠质量比较(x±s，分)

Table 4. Comparison of sleep quality before and after intervention in patients with depression and sleep disorders in two groups (x±s, points)

组别	例数	AIS		SIS
组别	例数	干预前	干预后	干预前	干预后
对照组	96	16.72±3.58	14.11±3.14	19.02±4.05	15.91±3.17
观察组	97	16.83±3.75	11.05±2.33	18.94±3.85	12.24±2.80
t值		0.208	7.694	0.141	8.527
P值		0.835	< 0.001	0.888	< 0.001

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表 5 2组抑郁症伴睡眠障碍患者干预前后正念觉知能力比较(x±s，分)

Table 5. Comparison of mindfulness awareness ability before and after intervention in two groups of patients with depression and sleep disorders (x±s, points)

组别	例数	观察		描述		有觉知的行动
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	96	18.92±2.16	21.22±2.20	20.82±2.55	21.81±3.10	19.06±2.08	19.96±2.61
观察组	97	19.46±2.34	24.75±2.41	20.67±2.13	23.67±2.65	18.93±1.94	22.05±2.92
t值		1.665	10.624	0.444	4.482	0.449	5.241
P值		0.097	< 0.001	0.658	< 0.001	0.954	< 0.001

组别	例数	不判断		不反应		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	96	19.76±1.99	19.98±2.73	18.66±2.15	19.50±2.55	97.88±8.64	104.51±10.35
观察组	97	19.83±2.18	21.83±2.62	18.57±1.86	21.81±2.27	98.12±7.32	113.83±9.22
t值		0.233	4.803	0.311	6.649	0.208	6.607
P值		0.816	< 0.001	0.756	< 0.001	0.835	< 0.001

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