正念认知治疗对抑郁障碍患者早期适应不良图式的影响

The influence of mindfulness cognitive therapy on the early maladaptive schema in patients with depression

目的:评价正念认知治疗(mindfulness-based cognitive therapy,MBCT)改善抑郁障碍的效果,并探索对患者早期适应不良图式(EMSs)的影响。方法:采用自身前后对照设计,纳入抑郁障碍患者60例,开展为期8周的MBCT治疗,分别于干预前、干预第4周后和干预第8周后进行17项汉密尔顿抑郁量表(Hamilton depression scale-17,HAMD-17)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、五因素正念量表(five facet mindfulness questionnaire,FFMQ)、Young图式问卷-短版(Young schema questionnaire-short form,YSQ-SF)评估。使用单因素重复测量方差分析和Kruskal-Wallis检验比较三个时间点量表评分,使用Pearson相关分析和多元线性回归分析探究抑郁焦虑症状改善程度与正念水平、图式变化的关系。结果:HAMD-17、HAMA、FFMQ总分在基线[(15.4±5.0)分、(21.0±9.6)分、(115.8±11.7)分]、干预4周末[(11.4±6.7)分、(15.9±10.1)分、(121.9±14.2)分]和干预8周末[(11.0±6.2)分、(15.4±8.7)分、(122.6±15.5)分]三个时间点均差异有统计学意义(F=25.22,20.95,14.02,均P<0.01)。进一步两两比较,治疗4周末和8周末抑郁障碍患者HAMD-17、HAMA总分均较基线下降(均P<0.05),FFMQ总分较基线增加(P<0.05);治疗8周与4周比较,患者HAMD-17、HAMA、FFMQ总分均差异无统计学意义(均P>0.05)。YSQ-SF中的情感剥夺、遗弃/不稳定、失败、脆弱/对伤害或疾病的易感性、纠结/未发展的自我、苛刻的标准/苛求、权利感/优越感分量表分在三个时间点均差异有统计学意义(H=2.00~17.11,均P<0.05)。线性回归分析显示,FFMQ总分差值与HAMA总分差值呈线性关系(β=-0.363)、情感剥夺量表分差值与HAMD-17总分差值呈线性关系(β=0.292),依赖/无能力和屈从量表分差值与HAMA总分差值呈线性关系(β=0.334、0.278)。结论:MBCT可改善抑郁障碍患者的焦虑抑郁症状,部分EMSs的改善可能是MBCT改善抑郁障碍的机制。

Objective To evaluate the effect of mindfulness-base cognitive therapy(MBCT)in improving patients with depression,and to explore its effect on patients early maladaptive schemas(EMSs).Methods Sixty patients with depressive disorder were included in the pre-and post-control design,and MBCT treatment was carried out for 8 weeks.The Hamilton depression scale-17(HAMD-17),Hamilton anxiety scale(HAMA),five facet mindfulness questionnaire(FFMQ),and Young schema questionnaire-short form(YSQ-SF)were used for evaluation.The scores of the three time points were compared by one-way repeated measure ANOVA and Kruskal Wallis test.Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between the improvement degree of depression and anxiety symptoms,as well as the changes of mindfulness level and schema.Results There were significant differences in the total scores of HAMD-17,HAMA and FFMQ at baseline((15.4±5.0),(21.0±9.6),(115.8±11.7)),4 weeks after intervention((11.4±6.7),(15.9±10.1),(121.9±14.2))and 8 weeks((11.0±6.2),(15.4±8.7),(122.6±15.5))after intervention(F=25.22,20.95,14.02,allP<0.01).Further pairwise comparison,compared with baseline,the total scores of HAMD-17 and HAMA in patients with depression decreased(all P<0.05),and the total scores of FFMQ increased(all P<0.05)in 8 weeks and 4 weeks after treatment.There were no significant differences in the total scores of HAMD-17,HAMA and FFMQ between 8 weeks and 4 weeks after treatment(all P>0.05).There were significant differences on the scores of the emotional deprivation,abandonment/instability,failure,vulner ability to harm or illness,enmeshment/undeveloped self,unrelenting standards/hypercriticalness,and entitlement/grandiosity subscales in the YSQ-SF(H=2.00-17.11,all P<0.05).Regression analysis showed that the FFMQ total score difference has a linear relationship with the HAMA total score difference(β=-0.363).There was a linear relationship between the emotional deprivation scale score difference and the HAMD-17 total score difference(β=-0.292).Dependence/incompetence and submission scale score difference showed a linear relationship with the HAMA total score difference(β=0.334,0.278).Conclusion MBCT can improve the anxiety and depression symptoms of patients with depression,and the improvement of some EMSs may be the mechanism of MBCT in the treatment of depression.