接纳承诺疗法对原发性肝癌患者主要照顾者心理灵活性、自我同情和焦虑抑郁情绪的影响

The influence of acceptance and commitment therapy on the psychological flexibility,self-compassion,anxiety and depression of the primary caregivers of patients with primary liver cancer

目的探讨接纳承诺疗法对原发性肝癌患者主要照顾者心理灵活性、自我同情和焦虑抑郁情绪的干预效果,为开展癌症患者主要照顾者临床护理提供参考。方法本研究为前瞻性研究。选取2021年7—12月武汉科技大学附属天佑医院治疗的原发性肝癌患者的主要照顾者80名为研究对象,按照随机抽签法将主要照顾者分为对照组和干预组,每组40名。对照组实施常规护理,干预组在常规护理基础上实施接纳承诺疗法。于干预前、出院当天、出院后1个月采用接纳与行动问卷第2版(AAQ-Ⅱ)、自我同情量表简化版(SCS-SF)和医院焦虑抑郁量表(HADS)评价2组主要照顾者的干预效果。结果71名主要照顾者完成干预和随访,其中对照组36名,干预组35名。干预前,2组主要照顾者AAQ-Ⅱ、SCS-SF、焦虑亚量表(HADS-A)、抑郁亚量表(HADS-D)得分比较差异无统计学意义(P>0.05)。干预组在出院当天、出院后1个月的AAQ-Ⅱ得分分别为(19.63±2.59)、(19.12±2.20)分,低于对照组的(23.14±2.49)、(22.56±2.40)分,差异均有统计学意义(t=5.83、6.25,均P<0.01);干预组在出院当天、出院后1个月的SCS-SF得分分别为(39.34±2.68)、(39.89±2.81)分,高于对照组的(36.69±3.08)、(37.72±2.41)分,差异均有统计学意义(t=-3.86、-3.49,均P<0.01);干预组在出院当天、出院后1个月的HADS-A、HADS-D得分分别为(9.31±1.95)、(9.09±1.60)分和(8.80±2.15)、(8.54±1.75)分,低于对照组的(11.42±1.50)、(11.03±1.70)分和(10.11±1.92)、(10.03±1.84)分,差异均有统计学意义(t值为2.71~5.10,均P<0.01)。2组的AAQ-Ⅱ、SCS-SF、HADS-A和HADS-D得分采用重复测量方差分析,时间效应、组间效应及交互效应的差异均有统计学意义(F值为3.42~37.90,均P<0.05)。结论接纳承诺疗法能够提高原发性肝癌患者主要照顾者的自我同情水平和心理灵活性,缓解焦虑和抑郁的情绪。

Objective To explore the intervention effect of acceptance and commitment therapy on the psychological flexibility,self-compassion,anxiety and depression of the primary caregivers of patients with primary liver cancer,so as to provide reference for the clinical care of the primary caregivers of cancer patients.Methods This was a prospective study.A total of 80 primary caregivers of patients with primary liver cancer treated in Tianyou Hospital Affiliated to Wuhan University of Science and Technology from July to December 2021 were selected as the observation objects,and they were randomly divided into the control group and the intervention group according to the random drawing method,with 40 cases in each group.The control group was given routine nursing measures,while the intervention group was given acceptance and commitment therapy on the basis of routine nursing.The intervention effect was evaluated by the Acceptance and Action Questionnaire-2nd Edition(AAQ-Ⅱ),Self-Compassion Scale Short-Form(SCS-SF)and Hospital Anxiety and Depression Scale(HADS)before the intervention,on the day of discharge,and one month after discharge.Results Finally,71 primary caregivers completed the intervention and follow-up,36 in the control group and 35 in the intervention group.Before the intervention,there was no statistically significant difference in the scores of AAQ-Ⅱ,SCS-SF,Anxiety subscale of HADS(HADS-A)and Depression subscale of HADS(HADS-D)between the two groups(P>0.05).The AAQ-Ⅱscores of the intervention group on the day of discharge and one month after discharge were(19.63±2.59),(19.12±2.20)points,which were significantly lower than those of the control group(23.14±2.49),(22.56±2.40)points.The differences were statistically significant(t=5.83,6.25,both P<0.01).The SCS-SF scores of the intervention group on the day of discharge and one month after discharge were(39.34±2.68),(39.89±2.81)points,which were significantly higher than those of the control group(36.69±3.08),(37.72±2.41)points,the differences were statistically significant(t=-3.86,-3.49,both P<0.01).The HADS-A/HADS-D scores of the intervention group on the day of discharge and one month after discharge were(9.31±1.95),(9.09±1.60)points and(8.80±2.15),(8.54±1.75)points,which were significantly lower than those of the control group(11.42±1.50),(11.03±1.70)points and(10.11±1.92),(10.03±1.84)points,the differences were statistically significant(t values were 2.71-5.10,all P<0.01).The scores of AAQ-Ⅱ,SCS-SF,HADS-A and HADS-D of the two groups were analyzed by repeated measures analysis of variance,and there were significant differences in time effect,inter-group effect and interaction effect(F vaules were 3.42-37.90,all P<0.05).Conclusions Acceptance and commitment therapy can improve the self-compassion and psychological flexibility,reduce anxiety and depression of the primary caregivers of patients with primary liver cancer.