“互联网+”辩证行为疗法干预模式在青少年非自杀性自伤干预中的应用研究

Application Research of"Internet+"Dialectical Behavior Therapy Intervention Mode in Adolescent Non-suicidal Self-injury Intervention

背景青少年非自杀性自伤已成为日益严重的精神卫生问题,其病程迁延,对患者、家庭、社会造成沉重负担。对青少年非自杀性自伤干预需要采用综合干预模式,我国线上干预管理实践尚处于起步阶段。目的探讨“互联网+”辩证行为疗法(DBT)干预模式对青少年非自杀性自伤患者自杀意念、认知情绪调节、缓解抑郁等方面的干预效果。方法选取2021年5月—2022年5月新乡医学院第二附属医院系统中出院的青少年非自杀性自伤患者120例为研究对象,采用随机对照单盲法,分为对照组(n=60)和干预组(n=60)。对照组进行药物干预、电话随访及心理咨询,干预组在对照组的基础上实施为期1年的“互联网+”DBT训练,分为4个模块,分别是正念训练、人际效能训练、情绪调节训练和忍受痛苦训练。在干预前及干预6、12个月后,分别采用青少年自杀意念自评量表(SIOSS)、认知情绪调节问卷(CERQ-C)、Montgomery-Asberg抑郁量表(MADRS)评价两组患者的自杀意念、认知情绪调节、抑郁状态。采用重复测量方差分析对不同时间点两组患者健康状态进行比较。结果最终对照组57例、干预组55例完成研究。组间与时间对SIOSS、CERQ-C、MADRS评分有交互作用(P<0.05);组间对SIOSS、CERQ-C、MADRS评分主效应显著(P<0.05),时间对SIOSS、CERQ-C、MADRS评分主效应显著(P<0.05)。其中干预组组内干预前后SIOSS、CERQ-C、MADRS评分比较,差异有统计学意义(P<0.001);对照组组内前后SIOSS评分、MADRS评分和CERQ-C评分中积极重新关注、重新关注计划、积极重新评价、理性分析、灾难化、责难他人维度比较,差异无统计学意义(P>0.001),对照组组内前后CERQ-C评分中自我责难、接受、沉思维度比较,差异有统计学意义(P<0.001)。结论“互联网+”DBT干预模式可以有效降低青少年非自杀性自伤患者的自杀意念,提高情绪控制水平,缓解抑郁状态,改善患者生存质量和社会功能。

Background Adolescent non-suicidal self-injury has become an increasingly serious mental health problem,and its course is protracted,causing serious burdens to patients,families and society.Intervention of non-suicidal self-injury in adolescents requires a comprehensive intervention model,and the practice of online intervention management in China is still in its infancy.Objective To investigate the intervention effect of"Internet+"dialectical behavior therapy(DBT)on suicidal ideation,cognitive emotion regulation,and alleviation of depression in adolescent patients with non-suicidal selfinjury.Methods A total of 120 adolescent patients with non-suicidal self-injury who were discharged from the Second Affiliated Hospital of Xinxiang Medical University from May 2021 to May 2022 were selected and randomly divided into the control group(n=60)and intervention group by randomized controlled single-blind method(n=60).The control group received drug intervention,telephone follow-up and psychological counseling,the intervention group implemented a one-year"Internet+"DBT training based on the control group,which was divided into 4 modules of mindfulness training,interpersonal effectiveness training,emotion regulation training and pain tolerance training.Before the intervention,6 months and 12 months after the intervention,the Self-rating Idea of Suicide Scale(SIOSS),Chinese version of Cognitive Emotion Regulation Questionnaire,(CERQ-C)and Montgomery and Asberg Depression Rating Scale(MADRS)were used to evaluate the suicidal ideation,cognitive emotion regulation,and depression status of the two groups of patients.Repeated measures analysis of variance was used to compare the health status of the two groups at different time points.Results Finally,57 cases in the control group and 55 cases in the intervention group completed the study.There was an interaction between group and time on SIOSS,CERQ-C,and MADRS scores(P<0.05);the main effect of group on SIOSS,CERQ-C,and MADRS scores was significant(P<0.05),and the main effect of time on SIOSS,CERQ-C,and MADRS scores was significant(P<0.05).Among them,the difference was statistically significant when comparing the SIOSS,CERQ-C,and MADRS scores before and after intervention within the intervention group(P<0.001);there was no significant difference in positive refocus,refocusing on planning,positive reappraisal,rational analysis,catastrophizing,and blaming others dimensions in the SIOSS scores,MADRS scores,and CERQ-C scores before and after intervention within the control group(P>0.001).The difference was statistically significant when comparing the self-blame,acceptance,and contemplation dimensions of the CERQ-C scores before and after intervention within the control group(P<0.001).Conclusion The"Internet+"DBT intervention model can effectively reduce the suicidal ideation of adolescent patients with non-suicidal self-injury,improve the level of emotional control,relieve depression,and improve the quality of life and social function of patients.