道家认知疗法对冠状动脉粥样硬化性心脏病患者A型行为的干预作用(英文)

Interventional effect of Chinese daoistic cognitive therapy on type-A behavior of patients with coronary heart disease

背景:冠状动脉粥样硬化性心脏病(简称冠心病)作为心血管系统常见的心身疾病,其行为特征已受到国内外学者的密切关注。中国道家认知治疗对焦虑症患者的干预收到了良好的效果,而在心身疾病领域的应用有待进一步发展。目的:探讨道家认知疗法对冠心病患者A型行为的干预效果。设计:随机分组对照观察。单位:新乡医学院心理学系。对象:于2002-08/2004-01在长沙理工大学和湖南大学的职工医院选取离、退休并确诊为冠心病的患者206例为观察对象。随机数字表法分为心理治疗组104例和对照组102例。方法:对照组接受单纯药物治疗,心理治疗组接受药物治疗+道家认知治疗。药物种类及剂量具体为:①消心痛10mg/d。②氨酰心安25～50mg/d。③尼群地平20～30mg/d。④卡托普利25～50mg/d。道家认知治疗根据中国道家认知疗法介绍的操作程序,分为松静术、柔动术、病因分析会和保健心得4部分。对冠心病患者进行为期3个月的干预及6个月的随访,采用A型行为问卷和精神超脱价值观问卷进行干预前后评价。对照组在相同的时间内完成量表的评定。A型行为问卷有测谎校正量表、时间紧迫感、争强好胜和敌意3个分量表。剔除测谎校正量表≥7分者。时间紧迫感+争强好胜和敌意评分≥28分者为A型行为表现。精神超脱价值观问卷客观地测量被试社会生活、家庭生活和个人生活等方面精神超脱程度的价值观,得分越高其超脱程度越高,得分越低则其超脱程度越低。主要观察指标:两组患者治疗前后A型行为量表及精神超脱量表的评分和A型行为发生率的比较。结果:心理治疗组患者12例脱落;对照组患者15例脱落,脱落原因为外出或因事不能参加,对照组1例死亡,心理治疗组患者92例和对照组患者87例进入结果分析。①心理治疗组治疗3,6个月后A型行为量表的评分显著低于对照组,差异有显著性意义[(20.8±5.8),(24.2±5.3)分,t=4.072,P=0.000;(21.2±5.7),(24.2±4.8)分,t=3.809,P=0.000]。干预3个月后A型行为问卷评分较干预前明显减少,6个月后随访,A型行为问卷评分无进一步变化(P>0.05)。②心理治疗组治疗3,6个月后A型行为发生率显著低于对照组,差异有显著性意义(24/26,35/40,χ2=1.526,P=0.017);(26/28,35/40,χ2=1.463,P=0.021)。③心理治疗组治疗3,6个月后精神超脱量表的评分显著高于对照组,差异有显著性意义[(28.7±4.4),(27.2±3.6)分,t=8.506,P=0.000;(32.6±3.1),(27.0±3.4)分,t=11.371,P=0.000]。干预3个月后精神超脱价值观问卷评分明显比干预前增加(P<0.01),6个月后随访精神超脱价值观问卷评分有进一步增加(P<0.05)。结论:道家认知治疗可减少冠心病患者的A型行为,增加临床疗效,改善预后。

BACKGROUND： Coronary herat disease （CHD） is commonly seen psy- chosomatic disease of cardiovascular system. Its behavioral characteristics have been closely concerned by scholars at home and abroad. Chinese daoistie cognitive therapy works well in patients with anxiety, but its application in the field of psychosomatic disease needs further development. OBJECTIVE： To probe into the interventional effect of Chinese daoistic cognitive therapy on type-A behavior of patients with coronary heart disease （CHD）. DESIGN： A randomized controlled grouping observation. SETTING： Department of Psychology, Xinxiang Medical College. PARTICIPANTS： Totally 206 patients who were retired and received treatment in the Staff Hospitals of Changsha University of Science and Technology and Hunan University between August 2002 and January 2004 were recruited. They were randomly divided into psychotherapy group （n =104）and control group （n=104）. METHODS： Patients of control group underwent simple drug treatment and those of psychotherapy group underwent drug treatment ＋ daoistic cog nitive therapy. Drug and dosage： ①nifedipine 10 mg/d. ②betaxolol 25- 50 mg/d.③nitrendipine 20-30 mg/d. ④captopril 25-50 mg/d. Dapistic cognitive therapy was divided into four parts according to operation procedure： Loose and calm technique, the technique of soft movement, the meeting of analyzing the cause of CHD and the records of health care and what one has learned from study. Psychotherapy group received 3-month treatment with Chinese daoistie therapy and 6-month follow-up and control group only reeeived medieal treatment. Both groups were test on a type-A behavior questionnaire （TABQ） and a mental detachment scale. TABQ ineluded three-subscales： L scale is for measuring lie; TH scale for measuring time hurry and CH is for competition hostility. Subjects, whose value of L was equal to or beyond 7, were excluded. Subjects were considered as patients with type-A behavior if their TH＋CH value was equal to or beyond 28. The Mental Detachment Scale was used to measure patients＇s outlook of value concerning degree of mental detachment on social life, family life and personal life and so on. The higher the scores, the higher the patients＇ mental detachment; the lower the scores, the lower degree the patients＇ mental detachment. MAIN OUTCOME MEASURES： Comparison of scoring of TABQ and mental detachment scale and incidence of type-A behavior before and after therapy in patients between two groups. RESULTS： Twelve patients of psychotherapy group and 15 patients of eontrol group lost due to going out or other matters, 1 patient of control group died and finally, 92 patients of psychotherapy group and 87 patients of control group entered the stage of result analysis. ①The scores of TABQ after 3 or 6-month treatment were significantly lower in the psychotherapy group than in the control group, with significant difference [（20.8±5.8）, （24.2±5.3） scores,t=4.072,P=0.000];[（21.2±5.7）, （24.2±4.8） ,t=3.809, P =0.000]. The scores of TABQ were significantly decreased after 3-month intervention in comparison with before intervention, and there was no further change of scores of TABQ after 6-month follow-up （P 〉 0.05）, ② The incidence of type-A behavior after 3 or 6-month therapy was significantly lower in the psychotherapy group than in the control group, with significant difference （24/26, 35/40, x^2=1.526, P=0.017）; （26/28, 35/40, X^2=1.463, P=0.021）. ③ The scores of Mental Detachment Scale after 3 or 6-month therapy was significantly higher in the psychotherapy group than in the control group, with significant difference [（28.7±4.4）, （27.2±3.6） scores, t=8.506, P=0.000]; [（32.6±3.1）, （27.0±3.4） scores, t=11.371, P=0.000]. The scores of Mental Detachment Scale were significantly increased after 3-month intervention in comparison with before intervention （P〈 0.01） and scores of Mental Detachment Scale after 6-month follow up was further increased （P 〈 0.05）. CONCLUSION： Daoistic cognitive therapy can decrease type-A behavior, increase clinical therapeutic effect and improve prognosis of patients with CHD.