融合音乐回忆的内观认知疗法对慢性精神分裂症女性患者应对方式的效果

doi:10.3969/j.issn.1006-9771.2022.03.012

摘要/Abstract

摘要： 目的探究在内观认知疗法基础上应用音乐回忆技术对精神分裂症康复期女性患者应对方式的效果。方法 2020年5月,对本院住院慢性精神分裂症女性患者72例进行特质匹配,分为对照组48例和音乐组24例。两组均接受精神科常规药物治疗,对照组接受常规内观认知疗法,音乐组接受融合音乐回忆技术的内观认知疗法,共12周。干预前后,采用简易应对方式量表、抑郁自评量表和焦虑自评量表进行盲法评定。结果对照组5例因答题错误被剔除。各项指标分组主效应不显著(F < 0.567, P > 0.05),消极应对方式时间主效应显著(F = 6.968, P = 0.01),积极应对方式和抑郁自评量表评分交互效应显著(F > 4.227, P < 0.05)。结论融合音乐回忆的内观认知疗法对改善慢性精神分裂症女性患者的应对方式可能有一定优势。

关键词: 慢性精神分裂症, 女性, 内观认知疗法, 音乐回忆, 应对方式

Abstract: Objective To explore the effect of Naikan cognitive-music reminiscence therapy on coping style in female patients with chronic schizophrenia.Methods In May, 2020, 72 female patients with chronic schizophrenia from Beijing Huilongguan Hospital were assigned into control group (n = 48) and music group (n = 24) after trait matching. Both groups accepted routine medicine, while the control group accepted Naikan cognitive therapy, and the music group accepted Naikan cognitive therapy combined music reminiscence, for twelve weeks. They were blind assessed with Simplified Coping Style Questionnaire, Self-rating Depression Scale and Self-rating Anxiety Scale before and after intervention.Results There were five cases in the control group removed for erroneous response. The main effects of group were not significant for all the assessments (F < 0.567, P > 0.05). The main effect of time was significant for negative coping style score (F = 6.968, P = 0.01), and the interaction effects were significant for positive coping style score and Self-rating Depression Scale score (F > 4.227, P < 0.05).Conclusion Combining with music reminiscence, Naikan cognitive therapy may be advantageous for the coping style of female patients with chronic schizophrenia.

Key words: chronic schizophrenia, women, Naikan cognitive therapy, music reminiscence, coping style

于辉,尹誉霏,潘桂平,罗薇,马贵君,邵静,谭淑平,杨甫德. 融合音乐回忆的内观认知疗法对慢性精神分裂症女性患者应对方式的效果[J]. 《中国康复理论与实践》, 2022, 28(3): 350-355.

YU Hui,YIN Yufei,PAN Guiping,LUO Wei,MA Guijun,SHAO Jing,TAN Shuping,YANG Fude. Effects of Naikan cognitive-music reminiscence therapy on coping style for female patients with chronic schizophrenia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(3): 350-355.

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参考文献 25

[1]	FOLKMAN S, LAZARUS R S, GRUEN R J, et al. Appraisal, coping, health status, and psychological symptoms[J]. J Personality Social Psychol, 1986,50(3):571-579.
[2]	张林, 车文博, 黎兵. 大学生心理压力应对方式特点的研究[J]. 心理科学, 2005,28(1):36-41.
	ZHANG L, CHE W B, LI B. Psycol Sci, 2005,28(1):36-41.
[3]	廖友国. 中国人应对方式与心理健康关系的元分析[J]. 中国临床心理学杂志, 2014,22(5):897-900.
	LIAO Y G. Relationship between coping style and mental health: a meta-analysis[J]. Chin J Clin Psychol, 2014,22(5):897-900.
[4]	WALSH J, HOCHBRUECKNER R, CORCORAN J, et al. The lived experience of schizophrenia: a systematic review and meta-synjournal[J]. Soc Work Mental Health, 2006,14(6):607-624.
[5]	TONG Y S, WANG D F, CAO Y. The factor structure of coping strategies in schizophrenic patients[J]. Chin J Nerv Mental Dis, 2006,32(5):385-391.
[6]	HORAN W P, VENTURA J, MINTZ J, et al. Stress and coping responses to a natural disaster in people with schizophrenia[J]. Psychiatry Res, 2007,151(1):77-86.
[7]	殷爱华, 张敬悬, 李馨. 精神分裂症患者与正常人应对方式的对照研究[J]. 精神医学杂志, 2012,25(4):261-264.
	YIN A H, ZHANG J X, LI X. Control study about coping style between patients with schizophrenia and healthy controls[J]. J Psychiatry, 2012,25(4):261-264.
[8]	PALUMBO C, VOLPE U, MATANOV A, et al. Social networks of patients with psychosis: a systematic review[J]. BMC Res Note, 2015,8(1):1-12.
[9]	李振涛, 毛富强, 刘春起, 等. 内观-认知疗法的临床应用[J]. 健康心理学, 1996,4(1):50-52.
	LI Z T, MAO F Q, LIU C Q, et al. Health Psychol, 1996,4(1):50-52.
[10]	毛富强. 内观认知疗法的来源与流派[J]. 华人心理健康报, 2009,24:45-48.
	MAO F Q. Chin Psychol Health Time, 2009,24:45-48.
[11]	毛富强. 内观认知疗法理论与操作[J]. 中华行为医学与脑科学杂志, 2016,25(7):650-656.
	MAO F Q. The theory and practice of Naikan cognitive therapy[J]. Chin J Behav Med Brain Sci, 2016,25(7):650-656.
[12]	刘显阳, 张小刚, 刘飞, 等. 内观疗法对精神分裂症患者应对方式的影响[J]. 陕西医学杂志, 2017,46(1):63-65.
	LIU X Y, ZHANG X G, LIU F, et al. The influence on coping style in patients with schizophrenia by Naikan therapy[J]. Shaanxi J Med, 2017,46(1):63-65.
[13]	秦金梅, 占归来, 李君, 等. 内观治疗对精神分裂症疗效的Meta分析[J]. 心理月刊, 2020,15(17):1-5, 10.
	QIN J M, ZHAN G L, LI J, et al. Efficacy of NaiKan therapy for schizophrenia: a meta analysis[J]. Psychol Magaz, 2020,15(17):1-5, 10.
[14]	TODOROVIC A, LAL S, DARK F, et al. CBTp for people with treatment refractory schizophrenia on clozapine: a systematic review and meta-analysis[J]. [ahead of print]. J Ment Health, 2020. doi: 10.1080/09638237.2020.1836558.
[15]	马云, 李占江, 徐子燕, 等. 认知行为治疗对精神分裂症患者应对方式的影响[J]. 中国临床心理学杂志, 2013,21(3):455-457.
	MA Y, LI Z J, XU Z Y, et al. Chin J Clin Psychol, 2013,21(3):455-457.
[16]	SILVERMAN M J. The effect of song writing on knowledge of coping skills and working alliance in psychiatric patients: a randomized clinical effectiveness study[J]. J Music Ther, 2011,48(1):103-122.
[17]	高天. 接受式音乐治疗方法[M]. 北京: 中国轻工业出版社, 2011.
	GAO T. Receptive Music Therapy [M]. Beijing: China Light Industry Press, 2011.
[18]	张厚粲, 徐建平. 现代心理与教育统计学[M]. 北京: 北京师范大学出版社, 2002: 477.
	ZHANG H C, XU J P. Modern Psychological and Educational Statistics [M]. Beijing: Beijing Normal University Publishing House, 2002: 477.
[19]	American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders[M]. 4th ed. Washington, D.C.: American Psychiatric Association, 1995.
[20]	毛富强. 内观认知疗法研究[M]. 北京: 北京大学医学出版社, 2019.
	MAO F Q. Study of Naikan Cognitive Therapy [M]. Beijing: Peking University Medical Press, 2019.
[21]	汪向东, 王希林, 马弘 . 心理卫生评定量表手册(增订版)[M]. 北京:中国心理卫生杂志社社, 1999.
	WANG X D, WANG X L, MA H. Handbook of Mental Health Assessment Scale (modified)[M]. Beijing: China Journal of Mental Health, 1999.
[22]	尹誉霏, 童永胜, 李静雯, 等. 歌曲治疗技术对精神分裂症患者应对方式及症状改善作用的随机对照试验[J]. 中国心理卫生杂志, 2019,33(4):260-266.
	YIN Y F, TONG Y S, LI J W, et al. A randomized controlled trial of song techniques on coping style and clinical effect in patients with schizophrenia[J]. Chin Ment Health J, 2019,33(4):260-266.
[23]	SILVERMAN M J. Effects of educational music therapy on coping self-efficacy in acute psychiatric inpatients: a cluster-randomized effectiveness study[J]. Nordic J Music Ther, 2016,25(supl):149-150.
[24]	WHEELER B L. Music Therapy Handbook [M]. New York: The Guilford Press, 2015.
[25]	SCHELENBERG E G, PERETZ I. Music, language and cognition: unresolved issues[J]. Trends Cogn Sci, 2008,12(2):45-46.

变量	对照组 (n = 43)	音乐组 (n = 24)	F/χ²值	P值
年龄/岁	53.7±12.33	53.5±14.26	0.003	0.954
受教育年限/年	13.0±2.74	11.3±2.96	5.601	0.021
婚姻/n			0.069	0.793
已婚	13	8
其他	30	16
职业/n			3.743	0.053
无业	17	4
其他	26	20
病程/年	20.9±13.19	18.8±13.51	0.395	0.532
首次发病年龄/岁	32.4±14.88	33.8±16.13	0.135	0.714
分诊类型/n			0.336	0.562
偏执	38	20
其他	5	4

时间/周	主题	目标	NCT	融合音乐回忆的NCT
1	建立关系与导入	互相认识,介绍方法与设置	成员互相认识,介绍基础理论和操作步骤,讲解和学习内观手册,讨论治疗目标,布置内观任务,确立内观三主题和对象	同对照组
2	激发兴趣	挖掘积极资源,提高参与兴趣,增强深入内在探索的能量和勇气	讲解内观治疗、贝克认知疗法以及NCT历史故事和来源,讲解成功案例、应用与效果	增加团体音乐回忆,引导成员回忆积极的体验,如与家人旅行、有成就感的往事等
3	内观学习	帮助成员分散内观体验更为顺畅、深入和清晰	根据NCT指导手册指导成员分散内观体验	在分散内观前加入音乐回忆引导语,在分散内观时增加促进回忆的背景音乐
4	规范流程	进一步规范流程,提升和深化内观感受	通过成员分享感悟和提出问题,提供流程改善建议,帮助解除心理阻抗和发现问题	在导入和总结阶段增加团体互动和支持
5~8	内观体验	通过体验逐渐加深心理层次,增加成员换位思考和主客观结合的能力	深化和熟练内观三主题与亲近者的内观体验,指导成员总结、记录和分享,引导成员从静心阶段向专注阶段、感悟阶段过渡	教授成员运用与回忆相关的音乐或匹配自身情绪的音乐促进内观中的回忆,以深化情绪体验,加深内观中回忆的心理层次
9~12	认知调整	引导成员识别自动思维和真实性检验,对非理性认知进行调整	讲解自动式思维和非理性认知概念,引导成员理解、觉察和自我调整,在团体中进行具体事例的分享和交流	同前一主题

指标	组别	n	干预前	干预后
积极应对方式	对照组	43	36.1±7.67	33.9±9.21
	音乐组	24	34.3±6.19	36.5±7.67
消极应对方式	对照组	43	19.0±4.23	20.2±4.18
	音乐组	24	18.8±3.71	21.0±4.83
SAS	对照组	43	44.0±6.06	45.3±7.97
	音乐组	24	44.8±7.48	42.5±6.33
SDS	对照组	43	56.7±6.16	54.0±8.28
	音乐组	24	54.9±6.95	57.1±7.12

指标	分组		时间		分组×时间
指标	F值	P值	F值	P值	F值	P值
积极应对方式	0.043	0.837	< 0.001	0.991	4.742	0.033
消极应对方式	0.101	0.752	6.968	0.010	0.560	0.457
SAS	0.567	0.454	0.170	0.682	2.591	0.112
SDS	0.229	0.634	0.053	0.818	4.227	0.044