认知行为治疗和接纳承诺疗法对老年人焦虑抑郁的影响

Effect of cognitive behavior therapy and acceptance commitment therapy on anxiety and depression in the elderly

目的对比接纳承诺疗法（ACT）与认知行为疗法（CBT）对老年人焦虑抑郁的团体辅导效果，同时探讨ACT改善焦虑抑郁的心理机制。方法从北京四个社区筛选25名老年人进行团体辅导，ACT组12人，CBT组13人，采用正念注意觉知量表（MAAS）、老年焦虑量表（GAI）、老年抑郁量表（GDS）、心理僵化问卷（接纳与行动问卷AAQ-Ⅱ和认知融合问卷CFQ）分别在干预前（T1）、干预6次后（T2）和干预5周后（T3）进行评估。结果（1）正念水平上，在T2时点[ACT组：（80．31±6．18）分，CBT组（74．20±4．48）分，t=2．52，P〈0．05]和T3时点[ACT组：（82．20±4．48）分，CBT组：（70．00±12．23）分，t=4．56，P〈0．01]ACT组均高于CBT组，差异有统计学意义。（2）焦虑水平上，在T2时点[ACT组：（2．88±1．86）分，CBT组：（8．87±2．80）分，t=-8．15，P〈0．01]和T3时点[ACT组：（5．38±2．02）分，CBT组：（10．50±2．66）分，t=-6．93，P〈0．01]ACT组均低于CBT组，差异有统计学意义。（3）抑郁水平上，在T1时点[ACT组：（4．59±3．97）分，CBT组（7．89±6．39）分，t=-2．25，P〈0．05]ACT组低于CBT组，差异有统计学意义；CBT组在T1和T2比较时差异有统计学意义（t=2．92，P〈0．05）。（4）心理僵化水平，在T2时点[ACT组：（41．38±8．28）分，CBT组：（49．60±3．52）分，t=3．64，P〈0．01]和T3时点[ACT组：（40．80±7．66）分，CBT组：（52．47±6．23）分，t=-4．98，P〈0．01]ACT组均低于CBT组，差异有统计学意义。（5）经验性回避仅在ACT疗法与焦虑间的中介效应达到了显著水平，中介效应量为11．40％。结论在抑郁水平上CBT疗法效果优于ACT疗法；在正念、焦虑、心理灵活性水平上ACT疗法效果优于CBT疗法；以心理灵活性为心理机制的ACT疗法较CBT疗法更能提高个体的心理灵活性。

Objective To compare the effects of Acceptance Commitment Therapy（ACT） and Cognitive Behavior Therapy（CBT） on anxiety and depression in the elderly, and to explore the psychological mechanism of ACT to improve anxiety and depression. Methods A total of 25 elderly people were screened from four communities in Beijing.According to the place of residence, 12 persons were enrolled in the ACT group and 13 persons were enrolled in the CBT group.The mindful attention awareness scale, geriatric anxiety inventory ,geriatric depression scale, the acceptance and action questionnaire-Ⅱ and cognitive fusion questionnaire were evaluated before regrouping （T1）, after six regiments （T2） and 5 weeks after the end of the intervention （T3）. Results （ 1 ） On the level of mindfulness, the score of ACT group was higher than that in CBT group at T2（ACT：80.31±6.18,CBT：74.20±4.48,t= 2.52,P〈0.05） and T3（ACT：82.20±4.48,CBT：70.00± 12.23 ,t= 4.56,P〈0.01 ）. （2）On the level of anxiety there was significant difference between the two groups at T2 （ ACT ： 2.88 ± 1.86, CBT ： 8.87 ± 2.80, t = - 8.15, P〈 0.01 ） and T3 （ ACT ： 5.38 ± 2.02, CBT ： 10.50±2.66,t=-6.93 ,P〈0.01 ） ,and ACT group was higher than the CBT group. （3）On the levels of depression there was significant difference between the two groups at T 1 （ ACT ： 4.59 ±3.97, CBT ： 7.89± 6.39, t = -2.25 ,P〈0.05） ,the ACT group was lower than the CBT group.The CBT group on the levels of depression there was a significant difference T1 and T2 （t= 2.92 ,P〈0.05 ）. （4）On the level of psychological flexibility, there was a significant difference between the two groups at T2 （ ACT： 41.38 ± 8.28, CBT ： 49.60 ± 3.52, t = - 3.64, P〈0.01 ） and T3 （ ACT ：40.80±7.66, CBT： 52.47±6.23, t= -4.98, P〈0.01 ）, and ACT group was lower than the CBT group. （ 5 ） Empirical avoidance only achieved a significant level of intermediate effects between ACT therapy and anxiety.In the ACT group, the median effect of empirical avoidance on anxiety was 11.40%. Conclusion The effect of CBT on depression is better than that of ACT, while the effect of ACT on the level of mindfulness, anxiety and mental flexibility is better than that of CBT.ACT with psychological flexibility as a psychological mechanism can improve the mental flexibility of the individual more than the CBT.