情绪管理训练对冠心病患者认知性应对策略、心理健康及社会支持的影响

The effects of emotion management training on cognitive coping strategies, mental health, and social support among patients with coronary heart disease

目的基于康复助手构建以应对策略为核心的情绪管理训练, 并验证其对冠心病患者认知性应对策略、心理健康及社会支持的影响。方法 2021年6月—2022年12月选取郑州市某医院心血管病区的106名冠心病患者, 采用抛硬币法将106例冠心病患者分为干预组(n=53)和对照组(n=53)。干预组在常规的健康教育的基础上实施7周情绪管理训练模式, 对照组实施7周常规的健康教育。在基线、干预后对患者的认知性应对策略、心理健康和社会支持进行评分。统计软件采用SPSS 24.0。采用独立样本或配对t检验比较两组的认知性应对策略、心理健康及社会支持得分。采用Pearson分析认知性应对策略与心理健康及社会支持的相关性。结果冠心病患者非适应性应对策略得分(69.52±7.60)分、适应性应对策略得分(35.22±6.15)分、抑郁得分(8.82±2.66)分、焦虑得分(8.78±1.99)分、失眠得分(10.97±2.86)分及社会支持得分(57.48±9.79)分。干预后干预组冠心病患者的非适应性应对策略、责难自己、沉思、灾难化、责难他人、理性分析、失眠、焦虑、抑郁得分明显低于对照组(t=-7.742, -4.395, -4.781, -6.105, -6.256, -5.327, -6.017, -7.288, -7.749, 均P<0.05);而适应性应对策略、积极重新评价、重新关注计划及社会支持得分明显高于对照组(t=7.314, 6.733, 5.874, 3.562, 均P<0.05)。干预组前后测的认知性应对策略各维度、失眠、焦虑、抑郁及社会支持得分比较差异有统计学意义(均P<0.05), 而对照组前后测差异无统计学意义(均P>0.05)。相关分析显示, 冠心病患者的非适应性应对策略与抑郁、焦虑得分呈正相关(r=0.421, 0.408, 均P<0.05);而适应性应对策略与抑郁、失眠得分呈负相关(r=-0.225, -0.240, 均P<0.05), 与社会支持呈正相关(r=0.219, P=0.034)。结论基于康复助手的情绪管理训练能有效促进冠心病患者的心理健康及非适应性应对策略的积极转变, 提高其适应性应对策略及社会支持。

Objective To design a systematic emotion management training(EMT)targeted the characteristics of coping strategies based on rehabilitation assistant and explore the feasibility of online EMT in improving cognitive coping strategies,mental health,and social support of patients with coronary heart disease(CHD).Methods From June 2021 to December 2022,a total of 106 CHD patients were screened from cardiovascular units of a hospital in Zhengzhou.All participants were divided into the intervention group(n=53)and control group(n=53)using the coin toss method.The patients in intervention group received 7 weeks emotion management training on the basis of routine health education,the patients in control group received 7 weeks routine health education.The scores of cognitive coping strategies,anxiety,depression,and social support were measured at baseline and post-intervention.Statistical analysis was conducted using SPSS 24.0 software.The cognitive coping strategies,mental health and social support scores between two groups were compared using independent sample t-tests or paired t-test.Pearson analysis was used to examine the correlation between cognitive coping strategies,mental health and social support.Results The scores of adaptive coping strategies,maladaptive coping strategies,depression,anxiety,insomnia and social support in patients with CHD were(69.52±7.60),(35.22±6.15),(8.82±2.66),(8.78±1.99),(10.97±2.86),and(57.48±9.79),respectively.After intervention,the scores of maladaptive coping strategies,self-blame,rumination,catastrophizing,blaming others,putting into perspective,insomnia,anxiety,and depression in the intervention group were significantly lower than those in the control group(t=-7.742,-4.395,-4.781,-6.105,-6.256,-5.327,-6.017,-7.288,-7.749,all P<0.05).The scores of adaptive coping strategies,positive reappraisal,refocusing on planning and social support were significantly higher than those of the control group(t=7.314,6.733,5.874,3.562,all P<0.05).In the intervention group,there were statistically significant differences in cognitive coping strategies,anxiety,depression,insomnia and social support scores before and after the test(all P<0.05)and they were not statistically significantly different in the control group(all P>0.05).Correlation analysis showed that maladaptive coping strategies were positively correlated with depression and anxiety scores(r=0.421,0.408,both P<0.05).Adaptive coping strategies were negatively correlated with depression and insomnia scores(r=-0.225,-0.240,both P<0.05),and positively correlated with social support(r=0.219,P=0.034)among patients with CHD.Conclusion The online EMT based on rehabilitation assistant may be a useful intervention for patients with CHD which can promote psychological health,social support as well as positively transforming maladaptive coping strategies into adaptive coping strategies.