接纳与承诺疗法对精神分裂症患者病耻感、自我效能及依从性的影响

杨皓; 潘宇鸿; 王双; 周广凤

doi:10.16766/j.cnki.issn.1674-4152.003428

接纳与承诺疗法对精神分裂症患者病耻感、自我效能及依从性的影响

doi: 10.16766/j.cnki.issn.1674-4152.003428

杨皓¹,
潘宇鸿^2, ,,
王双³,
周广凤⁴

1.
哈尔滨精神专科白渔泡医院老年七疗科，黑龙江哈尔滨 150000
2.
哈尔滨精神专科白渔泡医院精神科六疗科
3.
大庆市第三医院精神科七病区，黑龙江大庆 164700
4.
哈尔滨精神专科白渔泡医院老年八疗科

基金项目:

黑龙江省卫生健康委科研项目 20220303090993

详细信息

通讯作者:
潘宇鸿，E-mail：286534720@qq.com

中图分类号: R749.3
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- 文章访问数: 318
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- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-02
- 网络出版日期: 2024-05-27

Effect of acceptance and commitment therapy on stigma, self-efficacy, and medication adherence in patients with schizophrenia

1.
Geriatric No.7 Department, Harbin Psychiatry Specialist Baiyupao Hospital, Harbin, Heilongjiang 150000, China

摘要

摘要: 目的精神分裂症患者具有严重的病耻感及较低的自我效能，影响患者的依从性和疾病的康复。本研究探讨接纳与承诺疗法对精神分裂症患者病耻感、自我效能及依从性的影响，以期为减轻精神分裂症患者的病耻感，提高其自我效能及依从性提供一种有效、安全的方法。方法选取2022年10月—2023年4月就诊于哈尔滨精神专科白渔泡医院门诊的精神分裂症患者为研究对象，将招募的178例精神分裂症患者使用随机数字列表法分为对照组89例和研究组89例，对照组给予常规药物治疗，研究组在此基础上给予接纳与承诺疗法。于干预前后采用精神疾病内化病耻感量表(ISMI)、一般自我效能量表(GSES)、Morisky服药依从性量表(MMAS-8)进行评估。结果干预后，研究组ISMI评分为(61.39±9.93)分，低于对照组的(67.34±10.48)分，GSES评分为(21.01±3.63)分，高于对照组的(19.21±3.93)分，MMAS-8评分为(7.66±1.21)分，高于对照组的(6.07±1.48)分，差异均有统计学意义(P＜0.05)。干预后，研究组ISMI评分为(61.39±9.93)分，低于干预前的(67.24±10.34)分，GSES评分为(21.01±3.63)分，高于干预前的(19.17±3.89)分，MMAS-8评分为(7.66±1.21)分，高于干预前的(6.01±1.42)分，差异均有统计学意义(P＜0.05)。结论接纳与承诺疗法能有效减轻精神分裂症患者的病耻感，提高其自我效能及依从性。
- 精神分裂症 /
- 接纳与承诺疗法 /
- 病耻感 /
- 自我效能 /
- 依从性
Abstract: Objective Patients with schizophrenia have a severe stigma and low self-efficacy, which seriously affects their medication adherence and recovery of the disease. This study explores the effects of acceptance and commitment therapy on the stigma, self-efficacy, and medication adherence of patients with schizophrenia, in order to provide an effective and safe method for reducing the stigma, improving self-efficacy, and medication adherence of patients with schizophrenia. Methods Patients with schizophrenia who visited the Harbin Psychiatry Specialist Baiyupao Hospital from October 2022 to April 2023 were selected as the research subjects. A total of 178 recruited patients with schizophrenia were divided into a control group of 89 cases and a study group of 89 cases using a random number list method. The control group received conventional drug treatment, while the study group received acceptance and commitment therapy. Before and after the intervention, the internalized stigma of mental illness scale (ISMI), general self efficacy scale (GSES), and Morisky medication adherence scale-8 (MMAS-8) were used to evaluate the efficacy of mental illness. Results After intervention, the ISMI score of the study group was (61.39±9.93) points, which was lower than that of the control group [(67.34±10.48) points], and the GSES score of the study group was (21.01±3.63) points, which was higher than that of the control group [(19.21±3.93) points], and the MMAS-8 score of the study group was (7.66±1.21) points, which was higher than that of the control group [(6.07±1.48) points], and the differences were statistically significant (P < 0.05). After intervention, the ISMI score of the study group was (61.39±9.93) points, which was lower than that before intervention [(67.24±10.34) points], and the GSES score of the study group was (21.01±3.63) points, which was higher than that before intervention [(19.17±3.89) points], and the MMAS-8 score of the study group was (7.66±1.21) points, which was higher than that before intervention [(6.01±1.42) points], and the differences were statistically significant (P < 0.05). Conclusion Acceptance and commitment therapy can effectively reduce the stigma in patients with schizophrenia, improve their self-efficacy and medication adherence.
- Schizophrenia /
- Acceptance and commitment therapy /
- Stigma /
- Self-efficacy /
- Medication adherence

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表 1 ACT课程内容

Table 1. Content of the ACT course

时间	内容
第1周	了解精神分裂症；了解病耻感；入组人员相互了解，逐渐形成整体团队；正常化问题；分析具体问题。
第2周	让入组的人员分享自己遭受嘲笑、歧视的真实经历，同时分享自身患病的真实感受；引导患者进行认知解离和接纳自我，接受现实。
第3周	通过正念训练引导入组人员看到其身边的资源，活在当下，提升控制情绪能力；引导入组人员学会寻求支持和帮助。
第4周	通过创造性无望让入组人员理解回避问题不是一种可取的方式；让入组人员了解如何有效拒绝回避；要从一个观察者的角度去对待遇见的问题，运用积极的方式处理遇见的问题。
第5周	明确价值；承诺行动做出改变；处理行动中的障碍；基于价值的目标表、迈出最小的一步。
第6周	探讨如何有效保持长期治疗效果；回顾和总结。

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表 2 2组精神分裂症患者一般情况比较

Table 2. Comparison of Baseline characteristics between two groups of patients with schizophrenia

组别	例数	年龄(x±s，岁)	受教育年限(x±s，年)	总病程(x±s，年)	PANSS量表评分(x±s，分)	性别[例(%)]		婚姻[例(%)]				首次发作[例(%)]
组别	例数	年龄(x±s，岁)	受教育年限(x±s，年)	总病程(x±s，年)	PANSS量表评分(x±s，分)	男性	女性	未婚	已婚	离异	丧偶	是	否
研究组	71	40.44±9.05	12.01±3.29	18.41±7.48	48.51±6.89	34(47.89)	37(52.11)	18(25.35)	41(57.75)	11(15.49)	1(1.41)	5(7.04)	66(92.96)
对照组	73	40.10±9.43	11.92±3.26	18.12±7.72	48.03±6.80	33(45.21)	40(54.79)	20(27.40)	42(57.53)	9(12.33)	2(2.74)	3(4.11)	70(95.89)
统计量		0.221^a	0.176^a	0.225^a	0.421^a	0.104^b		0.623^b				0.590^b
P值		0.825	0.860	0.822	0.675	0.747		0.891				0.442
注：^a为t值，^b为χ²值。

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表 3 2组精神分裂症患者ISMI总评分及各因子评分、GSES评分、MMAS-8评分比较(x±s, 分)

Table 3. Comparison of the total ISMI scores, various factor scores, GSES scores, and MMAS-8 scores between two groups of patients with schizophrenia (x±s, points)

组别	例数	ISMI总分		疏远因子得分		刻板因子得分		歧视因子得分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
研究组	71	67.24±10.34	61.39±9.93^a	13.87±3.84	12.54±3.62^a	15.35±4.06	13.91±3.57^a	10.68±2.59	9.76±2.82^a
对照组	73	67.36±10.78	67.34±10.48	13.92±4.07	13.88±3.97	15.33±4.14	15.40±4.06	9.56±2.58	9.93±2.64
t值		0.066	3.494	0.068	2.115	0.086	2.323	1.665	0.375
P值		0.947	0.001	0.946	0.036	0.973	0.022	0.098	0.708

组别	例数	抵抗因子得分		社会退缩因子得分		GSES得分		MMAS-8得分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
研究组	71	13.31±3.06	12.15±3.20^a	14.03±3.46	13.03±3.54^a	19.17±3.89	21.01±3.63^a	6.01±1.42	7.66±1.21^a
对照组	73	13.18±3.10	13.27±3.08	14.97±3.49	14.86±3.60	19.29±3.95	19.21±3.93	6.05±1.51	6.07±1.48
t值		0.257	2.137	1.631	3.083	0.181	2.868	0.167	7.058
P值		0.798	0.034	0.105	0.005	0.856	0.005	0.868	＜0.001
注：与同组干预前比较，^aP＜0.01。

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参考文献(28)

[1]	JAGUAR S, JOHNSTONE M, MCKENNA P J. Schizophrenia[J]. Lancet, 2022, 399(10323): 473-486. doi: 10.1016/S0140-6736(21)01730-X
[2]	余林花, 王铁虎. 复发性精神分裂症患者生活质量状况调查及影响因素分析[J]. 中华全科医学, 2022, 20(5): 821-823, 858. doi: 10.16766/j.cnki.issn.1674-4152.002463 YU L H, WANG T H. Quality of life in patients with recurrent schizophrenia and analysis of influencing factors[J]. Chinese Journal of General Practice, 2022, 20(5): 821-823, 858. doi: 10.16766/j.cnki.issn.1674-4152.002463
[3]	YI Q F, YANG G L, YAN J. Self-efficacy intervention programs in patients with chronic obstructive pulmonary disease: narrative review[J]. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3397-3403. doi: 10.2147/COPD.S338720
[4]	WANG L Y, LI M Z, JIANG X J, et al. Mediating effect of self-efficacy on the relationship between perceived social support and resilience in patients with recurrent schizophrenia in China[J]. Neuropsychiatr Dis Treat, 2022, 18: 1299-1308. doi: 10.2147/NDT.S368695
[5]	YU W, TONG J, SUN X, et al. Analysis of medication adherence and its influencing factors in patients with schizophrenia in the chinese institutional environment[J]. Int J Environ Res Public Health, 2021, 18(9): 4746. doi: 10.3390/ijerph18094746
[6]	TOWNSEND M, PAREJA K, BUCHANAN-HUGHES A, et al. Antipsychotic-related stigma and the impact on treatment choices: a systematic review and framework synthesis[J]. Patient Prefer Adherence, 2022, 16: 373-401. doi: 10.2147/PPA.S343211
[7]	LUO H, LI Y, YANG B X, et al. Psychological interventions for personal stigma of patients with schizophrenia: a systematic review and network meta-analysis[J]. J Psychiatr Res, 2022, 148: 348-356. doi: 10.1016/j.jpsychires.2022.02.010
[8]	ABDISA E, FEKADU G, GIRMA S, et al. Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia[J]. Int J Ment Health Syst, 2020, 14: 56. doi: 10.1186/s13033-020-00391-6
[9]	LOOTS E, GOOSSENS E, VANWSEMAEL T, et al. Interventions to improve medication adherence in patients with schizophrenia or bipolar disorders: a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2021, 18(19): 10213. DOI: 10.3390/ijerph181910213.
[10]	郭辉, 勾玉莉, 沙丽艳. 慢性疼痛患者疼痛恐惧心理研究进展[J]. 中国护理管理, 2020, 20(4): 623-627. doi: 10.3969/j.issn.1672-1756.2020.04.030 GUO H, GOU Y L, SHA L Y. Research progress on pain fear psychology in patients with chronic pain[J]. Chinese Nursing Management, 2020, 20(4): 623-627. doi: 10.3969/j.issn.1672-1756.2020.04.030
[11]	莫祖娥, 饶悦. 接纳与承诺疗法在糖尿病中的应用进展[J]. 河北医药, 2019, 41(24): 3797-3802. doi: 10.3969/j.issn.1002-7386.2019.24.029 MO Z E, RAO Y. Research progress on the application acceptance and commitment therapy in treatment of diabetes mellitus[J]. Hebei Medical Journal, 2019, 41(24): 3797-3802. doi: 10.3969/j.issn.1002-7386.2019.24.029
[12]	张琳. 团体接纳承诺疗法在精神分裂症康复期患者中的应用效果[J]. 中西医结合护理, 2021, 7(9): 85-87. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL202109023.htm ZHANG L. The application effect of group acceptance commitment therapy in rehabilitation patients with schizophrenia[J]. Journal of Clinical Nursing in Practice, 2021, 7(9): 85-87. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXHL202109023.htm
[13]	李莉, 史俊研, 贾跃辉, 等. 接纳承诺疗法对精神分裂症康复期患者病耻感及自我效能感的影响[J]. 世界最新医学信息文摘, 2019, 19(20): 57-58. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201920025.htm LI L, SHI J Y, JIA Y H, et al. Effect of acceptance and commitment therapy (ACT) on stigma and self-efficacy in patients with schizophrenia during rehabilitation[J]. World Latest Medicine Information, 2019, 19(20): 57-58. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201920025.htm
[14]	汤秀成, 丁跃庆, 周娜, 等. 接纳承诺疗法对双相情感障碍患者疗效及社会功能的影响[J]. 国际精神病学杂志, 2022, 49(2): 212-215. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202202004.htm TANG X C, DING Y Q, ZHOU N, et al. The Influence of acceptance commitment therapy on the efficacy and social function of patients with bipolar disorder[J]. Journal of International Psychiatry, 2022, 49(2): 212-215. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202202004.htm
[15]	KOMATSU H, ONO T, ONOGUCHIN G, et al. Mediating effects of self-stigma and depression on the association between autistic symptoms and recovery in patients with schizophrenia-spectrum disorders: a cross-sectional study[J]. BMC Psychiatry, 2021, 21(1): 464. doi: 10.1186/s12888-021-03472-z
[16]	SUN Y, WANG M, ZHOU Y, et al. The mediating effect of family function and medication adherence between symptoms and mental disability among Chinese patients with schizophrenia: a cross-sectional study[J]. Psychol Health Med, 2019, 24(5): 559-569. doi: 10.1080/13548506.2018.1533248
[17]	吕阳, 李东艳, 董妞, 等. 团体接纳与承诺疗法对结直肠癌患者反刍性沉思和心理一致感的影响[J]. 中国健康心理学杂志, 2021, 29(7): 1055-1059. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202107023.htm LYU Y, LI D Y, DONG N, et al. Effect of group acceptance and commitment therapy on ruminant contemplation and psychological coherence inpatients with colorectal cancer[J]. China Journal of Health Psychology, 2021, 29(7): 1055-1059. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202107023.htm
[18]	陈玥, 祝卓宏. 接纳承诺疗法在抑郁症治疗中的应用[J]. 中国心理卫生杂志, 2019, 33(9): 679-684. doi: 10.3969/j.issn.1000-6729.2019.09.008 CHEN Y, ZHU Z H. A review of acceptance and commitment therapy for depression[J]. Chinese Mental Health Journal, 2019, 33(9): 679-684. doi: 10.3969/j.issn.1000-6729.2019.09.008
[19]	张含, 王会聪, 郭永攀, 等. 接纳与承诺疗法对创伤性截肢患者反刍性沉思及生活质量的影响[J]. 中国健康心理学杂志, 2021, 29(7): 965-969. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202107003.htm ZHANG H, WANG H C, GUO Y P, et al. The effect of acceptance and commitment therapy on rumination and quality of life in patients with traumatic amputation[J]. China Journal of Health Psychology, 2021, 29(7): 965-969. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202107003.htm
[20]	POLAT H, ASI KARAKAS S. The effect of acceptance and commitment therapy orientated anger management training on anger ruminations and impulsivity levels in forensic psychiatric patients: a randomized controlled trial[J]. Perspect Psychiatr Care, 2021, 57(4): 1616-1627. doi: 10.1111/ppc.12726
[21]	刘会静, 刘维, 董建清, 等. 目的性反刍性沉思与家庭环境交互作用对首诊前列腺癌骨转移老年患者心理痛苦的影响[J]. 中华全科医学, 2019, 17(10): 1722-1725. doi: 10.16766/j.cnki.issn.1674-4152.001040 LIU H J, LIU W, DONG J Q, et al. Interaction of rumination meditations in purpose and family environment on psychological pain in elderly patients with first diagnosed bone metastasis of prostate cancer[J]. Chinese Journal of General Practice, 2019, 17(10): 1722-1725. doi: 10.16766/j.cnki.issn.1674-4152.001040
[22]	GAUDIANO B A, ELLENBERG S, OSTROVE B, et al. Feasibility and preliminary effects of implementing acceptance and commitment therapy for inpatients with psychotic-spectrum disorders in a clinical psychiatric intensive care setting[J]. J Cogn Psychother, 2020, 34(1): 80-96. doi: 10.1891/0889-8391.34.1.80
[23]	ZEMESTANI M, MOZAFFARI S. Acceptance and commitment therapy for the treatment of depression in persons with physical disability: a randomized controlled trial[J]. Clin Rehabil, 2020, 34(7): 938-947. doi: 10.1177/0269215520923135
[24]	MOENS M, JANSEN J, DE SMEDT A, et al. Acceptance and commitment therapy to increase resilience in chronic pain patients: a clinical guideline[J]. Medicina (Kaunas), 2022, 58(4): 499. doi: 10.3390/medicina58040499
[25]	李莉, 史俊研, 李懋, 等. 接纳承诺疗法对精神分裂症康复期患者生活质量及应对方式的影响[J]. 国际精神病学杂志, 2019, 46(4): 644-647. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ201904020.htm LI L, SHI J Y, LI M, et al. Effect of acceptance and commitment therapy (ACT) on quality of life and coping style in patients with schizophrenia during rehabilitation[J]. Journal of International Psychiatry, 2019, 46(4): 644-647. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ201904020.htm
[26]	KOMATSU H, ONO T, MAITA Y, et al. Association between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders[J]. Neuropsychiatr Dis Treat, 2020, 16: 2553-2561. doi: 10.2147/NDT.S280485
[27]	MORGADES-BAMBA C I, FUSTER-RUIZDEAPODACA M J, MOLERO F. Internalized stigma and its impact on schizophrenia quality of life[J]. Psychol Health Med, 2019, 24(8): 992-1004. doi: 10.1080/13548506.2019.1612076
[28]	王丽丽, 白睿锋. ACT干预对乳腺癌改良根治术后患者自我接纳水平及自我效能感的影响[J]. 山西卫生健康职业学院学报, 2020, 30(6): 114-116. https://www.cnki.com.cn/Article/CJFDTOTAL-SXZG202006060.htm WANG L L, BAI R F. Effect of ACT intervention on self acceptance and self-efficacy of patients with breast cancer after modified radical mastectomy[J]. Journal of Shanxi Health Vocational College, 2020, 30(6): 114-116. https://www.cnki.com.cn/Article/CJFDTOTAL-SXZG202006060.htm