焦点解决、团体干预对双相情感障碍缓解期残留症状的影响

王媛媛; 冯虹; 林雪冰

doi:10.16766/j.cnki.issn.1674-4152.004094

焦点解决、团体干预对双相情感障碍缓解期残留症状的影响

doi: 10.16766/j.cnki.issn.1674-4152.004094

1.
绍兴市第七人民医院精一病区，浙江绍兴 312000
2.
绍兴市第七人民医院儿童精神科
3.
绍兴市第七人民医院医务科

基金项目:

浙江省卫生健康科技计划项目 2022RC279

详细信息

通讯作者:
冯虹，E-mail：13454522103@163.com

中图分类号: R749.05 R493
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- 文章访问数: 6
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出版历程
- 收稿日期: 2025-02-28
- 网络出版日期: 2025-10-25

The impact of focus resolution and group intervention on residual symptoms during the remission period of bipolar disorder

1.
Department One of Psychiatry, Shaoxing Seventh People's Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的缓解期双相情感障碍(BD)患者仍有一定残留症状及病耻感，严重影响患者心理健康水平及认知灵活性，本研究将焦点解决、团体干预应用于BD缓解期患者中，以期减轻患者残留症状、病耻感，提高患者认知灵活性。方法选取2024年1月—2025年1月就诊于绍兴市第七人民医院的310例BD缓解期患者为研究对象，采用随机数字表法将患者分为对照组(155例)和观察组(155例)。对照组患者采用常规护理，观察组在对照组基础上应用焦点解决、团体干预。采用杨氏躁狂量表(YMRS)及汉密尔顿抑郁量表(HAMD)评定患者残留躁狂、抑郁水平，采用精神疾病病耻感量表中文版(SSMI-C)及认知灵活性问卷(CFI)比较2组患者病耻感及认知灵活性水平。结果干预7周后，观察组患者YMRS及HAMD量表得分分别为(10.55±2.41)分、(8.42±1.43)分，均低于对照组[(13.01±2.57)分、(10.14±2.59)分，P＜0.05]。干预后，观察组患者SSMI-C总分低于对照组[(47.83±5.27)分vs.(71.75±7.46)分，P＜0.05]；观察组患者CFI量表总分高于对照组[(66.83±7.26)分vs. (57.32±7.41)分，F=6.786, P＜0.001]。结论焦点解决、团体干预可有效减轻BD缓解期患者残留症状，降低患者病耻感，提高认知灵活性，促进患者康复。
- 缓解期双相情感障碍 /
- 焦点解决模式 /
- 团体干预 /
- 残留症状 /
- 病耻感 /
- 认知灵活性
Abstract: Objective To analyze the residual symptoms and shame experienced by bipolar disorder (BD) patients in remission, with a view to understanding their impact on the patients'mental health and cognitive flexibility. The present study analyzes the application of the focus solution model group intervention in BD remission patients, with a view to alleviating residual symptoms and shame and improving cognitive flexibility. Methods The subjects of this study were selected from a cohort of 310 BD remission patients who had visited Shaoxing Seventh People's Hospital during the period between January 2024 and January 2025. The subjects were randomly divided into two groups: a control group and an observation group. The randomization method employed was a random number list method, with 155 cases in each group. The control group received routine nursing care, while the observation group received group intervention using the focus solution model on the basis of the control group. The Yang mania scale (YMRS) and Hamilton depression scale (HAMD) were utilized to evaluate the residual manic and depressive levels of patients. The stigma scale for mental illness (SSMI-C) and the cognitive flexibility inventory (CFI) were utilized to compare the shame and psychological flexibility levels of the two groups of patients. Results Following a period of seven weeks of intervention, the YMRS and HAMD scores of the patients in the observation group were found to be (10.55±2.41) points and (8.42±1.43) points, respectively. These figures were lower than those recorded for the control group, which were (13.01±2.57) points and (10.14±2.59) point, respectively. A P-value of less than 0.05 was obtained, indicating that the difference between the two groups was statistically significant. Following the intervention, the total score of SSMI-C in the observation group was lower than that in the control group (47.83±5.27 vs. 71.75±7.46, P < 0.05). The mean total score of the CFI in the observation group was higher than that in the control group (66.83±7.26 vs. 57.32±7.41, F=6.786, P < 0.001). Conclusion The focus solution model group intervention has been demonstrated to be an effective means of alleviating residual symptoms in BD patients during remission, reducing their sense of shame, enhancing psychological flexibility, and promoting their recovery.
- Bipolar disorder during the remission period /
- Focus solution mode /
- Group intervention /
- Residual symptoms /
- Shame of illness /
- Psychological flexibility

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表 1 BD缓解期患者SFGT具体内容

Table 1. Specific contents of SFGT in BD patients in remission

干预进程	干预目标	干预内容
第1周	通过团体互动明确患者的当前困扰与资源，聚焦于“问题解决”而非“问题分析”。	(1)结构化提问：入院当天收集患者资料，使用开放式提问引导患者表达内心想法(如“您现在最担心的问题是什么？”)，将患者描述的问题正常化，帮助患者从“问题描述”转向“解决导向”，跳出问题本身，转向积极思维。
		(2)团体共情：通过成员分享相似经历，降低患者对疾病的担忧及减轻病耻感。例如，讨论“社会误解、他人异常眼光”时，引导患者意识到病耻感是普遍现象，而非个人缺陷。
		(3)强化自我效能感：引导患者回忆既往解决问题时做出的努力，肯定其积极行为，并引导患者列举出已具备的应对策略(如亲友支持、兴趣爱好)，树立战胜疾病的信念。
第2周	将模糊的治疗期望转化为具体、可操作的目标。	采用“奇迹询问”“应对式问句”等方式引导患者想象问题解决时的情景，激发患者思维，探索其当前所做的努力及可能取得的成效，帮助患者构建未来充满无限可能的想象空间，进而制定具体可行的目标。例如，对社交回避者，初期目标为“与家人每日对话10 min”，逐步过渡至“参与社交活动”。
第3~4周	发现患者既往应对症状的成功案例，提炼有效策略以应对当前问题。	(1)例外日记：采用例外询问的方式引导患者回忆应对症状的“例外”情况，在患者叙述中找到例外的可能，并要求患者记录“情绪稳定时的行为模式”，例如规律作息、运动，分析其与症状缓解的关联。
		(2)团体角色扮演：模拟患者曾成功应对的场景，涵盖工作、社交、家庭等，根据患者特点分配角色，提供简单脚本或框架，帮助患者理解情境和角色，角色扮演后，讨论各自的感受和体验，分享应对策略，强化其应对技巧。
第5~6周	通过正向反馈巩固患者的进步，修正消极认知模式。	(1)积极反馈：在团体干预过程中即时肯定患者的微小进步，如“您今天分享时语气更平静了”，增强患者信心。在患者完成预期目标时对其所付出的努力给予反馈，例如“您觉得您的心理状态有所改善吗？”帮助患者分析改善的原因，挖掘患者自身潜在力量，积极给予正向反馈。
		(2)重构病耻感：引导患者将“疾病标签”转化为“康复历程”，例如讨论“双相情感障碍如何让我更理解他人情绪”。
		(3)同伴互助：鼓励成员间互相提供建议，例如“当我感到自卑时，我会提醒自己过去的成就”，形成同伴互助支持性网络。
第7周	通过量化与质性评估，验证干预效果并优化后续方案。	(1)残留症状评估：使用《汉密尔顿抑郁量表》《躁狂评定量表》定期评估残留症状。 (2)团体复盘：每阶段结束后开展团体讨论，分析目标达成度与障碍，例如“哪些策略对您最有效？”，调整下一阶段计划。

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表 2 2组BD缓解期患者一般资料比较

Table 2. Comparison of general data between two groups of BD patients in remission

项目	对照组(n=155)	观察组(n=155)	统计量	P值
性别(例)			0.117^a	0.732
男性	72	69
女性	83	86
年龄(x±s，岁)	39.82±3.91	40.43±4.15	1.332^b	0.184
病程(x±s，月)	40.75±5.71	39.77±6.04	1.468^b	0.143
文化程度(例)			0.829^c	0.661
初中及以下	30	24
中专/高中	58	62
大专及以上	67	69
就业情况(例)			0.966^a	0.326
在职	103	111
离职/其他	52	44
注：^a为χ²值，^b为t值，^c为Z值。

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表 3 2组BD缓解期患者临床症状对比(x±s，分)

Table 3. Comparison of clinical symptoms between two groups of BD patients in remission (x±s, points)

组别	例数	YMRS		HAMD
组别	例数	干预前	干预后	干预前	干预后
对照组	155	14.46±3.71	13.01±2.57^b	12.75±2.93	10.14±2.59^b
观察组	155	14.64±3.65	10.55±2.41^b	13.01±2.85	8.42±1.43^b
统计量		0.431^a	6.581^c	0.792^a	5.876^c
P值		0.667	＜0.001	0.429	＜0.001
注：^a为t值，^c为F值; 与同组干预前比较，^bP < 0.05。

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表 4 2组BD缓解期患者病耻感比较(x±s，分)

Table 4. Comparison of stigma between two groups of BD patients in remissio (x±s, points)

组别	例数	歧视		病情掩饰		积极效应		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	155	26.77±4.17	25.94±4.02	28.16±5.36	27.46±4.86	13.51±2.70	12.95±2.60	72.64±8.55	71.75±7.46
观察组	155	27.14±4.35	20.18±3.41^b	28.07±5.19	22.35±4.04^b	13.47±2.83	10.18±2.33^b	73.07±8.94	47.83±5.27^b
统计量		0.764^a	6.156^c	0.150^a	7.037^c	0.127^a	3.115^c	0.433^a	12.386^c
P值		0.445	＜0.001	0.881	＜0.001	0.899	0.001	0.665	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 5 2组BD缓解期患者认知灵活性比较(x±s，分)

Table 5. Comparison of cognitive flexibility between two groups of BD patients in remission (x±s, points)

组别	例数	可选择性		可控性		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	155	28.43±3.85	29.20±3.76	27.16±4.19	28.25±4.73	56.11±7.87	57.32±7.41
观察组	155	28.37±4.10	33.15±3.44^b	27.24±4.02	32.76±4.18^b	55.83±6.72	66.83±7.26^b
统计量		0.133^a	4.102^c	0.172^a	3.877^c	0.337^a	6.786^c
P值		0.894	＜0.001	0.864	0.001	0.736	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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