内观疗法联合改良森田疗法对老年癌痛患者创伤后成长的干预效果

Effect of intervention with the combination of Naikan therapy and modified Morita therapy on psychological distress and post traumatic growth in elderly patients with cancer pain

目的探讨内观疗法联合改良森田疗法对老年癌痛患者心理痛苦及创伤后成长的干预效果。方法前瞻性研究，将符合入选条件的90例老年癌痛患者，按随机数字表法随机分为2组，对照组45例用癌痛规范化治疗和护理，研究组45例在此基础上给予内观疗法和改良森田疗法。干预前后分别用心理痛苦温度计（DT）、心理痛苦问题量表（DPL）和创伤后成长评定量表（PTGI）进行评估。结果干预后研究组心理痛苦（1．8±0．1）分低于对照组（3．9±0．2）分（t=1．78，P〈0．05），心理痛苦问题列表中家庭问题（1．1±0．1）分、情感问题（1．2±0．4）分低于对照组（2．4±0．4）分、（2．9±0．1）分（t分别=1．41、1．63，均P〈0．05）。创伤后成长（66．0±19．9）分及人际关系（34．8±12．1）分、新的可能（25．2±10．1）分、个人力量（20．7±10．4）分、精神变化（11．6±5．6）分、欣赏生活（18．9±6．2）分高于对照组（45．3±27．6）分、（23．8±12．2）分、（13．7±4．4）分、（7．6±3．1）分、（5．4±2．7）分、（6．1±2．1）分（t分别=2．58、1．91、1．94、2．03、1．26、1．88，均P〈0．05）。结论内观疗法联合改良森田疗法可减轻老年癌痛患者心理痛苦，促进创伤后成长。

Objective To explore the effect of combined Naikan therapy and modified Morita therapy on psychological distress and post traumatic growth in elderly patients with cancer pain. Methods Ninety elderly patients with cancer pain were randomly assigned into two groups ; those in the study group（n = 45）were given Naikan therapy and modified Morita therapy for 4 weeks and those in the control group （n ： 45） were given standardized aerodyne treatment and standardized nursing care. All subjects were assessed with the Distress Thermometer and Problem Listand the Post traumatic Growth Inventory before and after Naikan therapy and modified Morita therapy. Results Compared with the control group, the study group was associated with significantly decreased scores of psychological distress （1.8 ± 0.1 vs. 3.9 ± 0.2, t = 1.78, P 〈 0.05 ）, emotional problems （ 1.2 ± 0.4, vs. 2.4±0.4,t=1.41,P〈0. 05）and family problems（1.1±0.1, vs. 2.9±0.1,t=1. 63,P〈0.05）. The study group also showed markedly higher scores in posttraumatic growth（66.0±19.9 vs. 45.3±27.6,t=2.58,P〈0.05） ,relationships to others（34.8±12. 1 vs. 23.8±12.2,t=1.91,P〈0.05） ,new possibilities（25.2±10.1 vs. 13.7±4.4 ,t= 1.94, P〈0.05）, personal strength（20.7 ± 10.4 vs. 7.6 ± 3.1,t= 2.03,P〈0.05）, spiritual change （11. 6± 5.6 vs. 5.4 ± 2.7, t = 1.26, P〈0.05）, and appreciation of life（ 18.9 ± 6.2 vs. 6.1 ± 2.1, t = 1.88, P〈 0.05 ） than the control group. Conclusions Naikan therapy and modified Morita therapy can decrease psychological distress and improve post traumatic growth in elderly patients with cancer pain.