【作者】 夏颖；

【导师】 张红静；

【作者基本信息】 山东大学 ， 应用心理学， 2007， 硕士

【摘要】 脑卒中是一种常见的心身疾病，有50％～70％的脑卒中患者会遗留有偏瘫，对其心理健康造成极大的危害。通过临床访谈可以发现，脑卒中偏瘫患者的行为特征、应对方式在患病前后发生了较大的改变，并且这种改变可能会影响到其心身功能的康复。为此，本研究旨在：1．探讨脑卒中偏瘫患者发病前后行为特征、应对方式及其变化；2．探讨脑卒中偏瘫患者的行为特征、应对方式与其心身功能的关系；3．制定适合脑卒中偏瘫患者的针对性的心理干预方案，并验证其有效性。研究一：患病前后行为特征、应对方式的变化及其与心身功能的相关性研究研究方法：对66例在山东省残疾人康复中心治疗的脑卒中偏瘫患者进行临床访谈和问卷测评。使用“半结构式访谈问卷”、“A型行为类型问卷”、“医学应对问卷”、“状态—特质愤怒表达方式问卷”来评定行为特征、应对方式。使用“汉密尔顿焦虑抑郁量表”、“脑卒中生活质量专用量表”、“日常生活能力问卷”、“简易智力状态检查表”、“Brunnstrom运动功能评分”来评定心身功能。研究结果：1．患病前一般特点：患病前1月内，大部分患者经历过负性应激事件；情绪反应主要表现为愤怒和激动。病前A型行为患者占有较高比例；病前A型行为总分及敌意竞争性得分均显著高于常模。面对病前负性应激事件，被试以积极面对为主。2．患病前后行为特征、情绪反应、应对方式的变化：病后A型行为比例显著低于患病前；A型行为总分、敌意竞争性得分显著低于患病前，但仍高于常模。情绪反应与患病前相比也有显著变化，以平静和抑郁为主；外向怒、状态怒的得分均显著低于患病前。应对方式与患病前相比发生了显著性变化，以逃避和屈服为主。3．患病后A型行为、应对方式、情绪表达方式与心身功能的相关及回归分析：除应对方式与焦虑之间无明显相关外，A型行为总分、敌意竞争性、应对方式、状态怒、外向怒均与焦虑、抑郁呈正相关，与生活质量、躯体功能呈负相关；回归分析显示：敌意竞争性为心身功能的主要影响因素；抑郁还受到应对方式的影响，躯体功能受到外向怒的影响。4．患病前后A型行为、情绪表达方式的变化与心身功能的相关及回归分析：除外向怒的变化与焦虑、生活质量、躯体功能无显著相关外，A型行为总分、敌意竞争性、状态怒、外向怒的变化均与焦虑、抑郁呈正相关，与生活质量、躯体功能呈负相关；回归分析显示：敌意竞争性的变化是心身功能的主要影响因素。研究二：针对脑卒中偏瘫患者A型行为、应对方式的心理干预实验研究方法：采用随机对照的方法，将全部被试分为干预组34例和对照组32例。干预组患者在住院期间接受心理干预，对照组患者不进行心理干预，两者均进行常规康复治疗。心理干预主要围绕改变脑卒中偏瘫患者不良行为方式、应对方式进行。每位患者周期为4周，每周1次，每次约1小时。干预内容包括知识教育与认知指导、认知行为干预两大方面。分别于干预前后测定所有被试的行为特征以及心身功能。评定工具同研究一，另外增加了归因方式的评定。研究结果：1．干预后干预组与对照组相比：其A型行为比例、A型行为总分、敌意竞争性、状态怒、外向怒、逃避、屈服、抑郁的评分均显著低于对照组；控制怒、面对、归因方式、生活质量、躯体功能各项评分显著高于对照组。2．干预前后干预组和对照组的变化：干预组干预后敌意竞争性、屈服、焦虑、抑郁得分均显著低于干预前；面对、归因方式、生活质量、躯体功能评分均显著高于干预前。对照组干预后的逃避得分显著低于干预前；归因方式中乐观性得分显著高于干预前。通过以上研究得出以下结论：1．脑卒中偏瘫患者A型行为者占有较高的比例，以高敌意、竞争性为主，病前特征性情绪反应是愤怒，应对方式是积极面对。2．脑卒中偏瘫患者患病前后行为特征、应对方式均发生了显著的变化：表现为敌意竞争性的显著下降；情绪反应由愤怒转变为平静、抑郁为主；应对方式由积极面对转变为屈服、逃避方式为主。3．脑卒中偏瘫患者患病后行为特征、应对方式的积极改善，对其心身功能的康复具有重要意义。4．敌意竞争性是影响焦虑、抑郁、生活质量、躯体功能的最重要因素。5．实施认知行为心理干预方案能够改进脑卒中偏瘫患者行为方式、应对方式，促进其心身功能康复，可以应用于临床实践。更多还原

【Abstract】 Stroke is a common psychosomatic disease. Among those who suffered from stroke, 50%～70% patients are hemiplegia which could do a harm to their psychological health. Through clinical interview, the characteristic of behavior and coping style of stroke hemiplegic patients have changed remarkably after morbidity. At the same time, the changes of behavior and coping style may effect the psychosomatic function rehabilitation. In order to testify the hypothesis, the purposes of the study were: 1.To probe the characteristic of behavior (type A behavior) and coping style before and after stroke morbidity; 2.To investigate the correlation between the changes of characteristic of behavior and coping style after morbidity and psychosomatic function. 3.To make the right schema for psychological intervention and to testify its validity.Research I: The Correlation between the Changes of Characteristic of Behavior and Coping Style after Morbidity and Psychosomatic FunctionMethods: 66 stroke hemiplegic patients who received treatment in the rehabilitation centers for disabled people of Shandong province were interviewed and tested by the researchers with psychological questionnaires. The questionnaires which were used to evaluate the characteristic of behavior and coping style included Semi-structure Interview questionnaire(SI), Type A Behavior Pattern Scale(TABP), Medical Coping Modes Questionnaire(MCMQ), State-Trait Anger expression Inventory(STAXI). The questionnaires which were used to evaluate the psychosomatic function included Hamilton Anxiety Scale(HAMA), Hamilton Depression Rating Scale(HRSD), Stroke Specific Quality of Life(SS-QOL), Activities of Daily Living Scale(ADL), Mini-Mental State Examination(MMSE), Brunnstrom test.Results: 1.The general characteristics before morbidity: most of patients have experienced negative events before morbidity. The characteristic of emotional expression was anger. The patients with type A behavior represented a high proportion in all subjects. There were significant differences between the norms and the scores of (TH+CH) and CH. Facing the same negative events, most of subjects adopted confronce as coping style. 2.The changes of behavior, coping style and emotional expression after morbidity: the emotional expression had changed significantly when compared with those before morbidity. Most of patients were inclined to be depression and calmness as emotional expression. The scores of Anger-out and State-anger were much lower than those before morbidity. The proportion of Type A behavior had decreased significantly when compared with those before morbidity. The scores of TH+CH and CH were much lower than those before morbidity, but still higher than the norms. Most of patients adopted avoidance and consignation as coping style. Compared to those before morbidity, the coping style had changed significantly. 3.The Correlation between the changes of characteristic of behavior and coping style after morbidity and psychosomatic function: TH+CH, CH, coping style, State-anger and Anger-out after morbidity were related to anxiety, depression, QOL and somatic function. With step liner regression, the most effective factor of anxiety, depression, QOL and somatic function were CH. Depression was affected by coping style at the same time. The somatic function was also affected by Anger-out. 4.The changes of TH+CH, CH, coping style, State-anger and Anger-out after morbidity were also related to anxiety, depression, QOL and somatic function. With step liner regression, the change of CH was the most effective factor of anxiety, depression, QOL and somatic function.Research II: Psychological intervention Focusing on the TABP and Coping StyleMethods: 66 subjects were divided randomly into 2 groups for contrast: intervention group (34) and control group (32). The former received psychological intervention and rehabilitation exercises. The latter only received rehabilitation exercises. The period of the intervention was about 4 weeks for each patient, 1 hour a week. The content included the education of knowledge and the intervention of cognition and behavior. All the subjects were tested before and after the intervention in order to investigate the effectiveness of the intervention on the TABP, coping style and psychosomatic function. The evaluation instruments consisted of Attributional Style Questionnaire (ASQ) and the tools which were used in research one.Results: 1.Compared with those of control group, the proportion of Type A behavior, the scores of TH+CH, CH, State-anger, Anger-out, avoidance, consignation, depression of intervention group were lower significantly. The scores of Anger-control, confronce, attributional style, psychosomatic function were much higher than those of control group. 2.The proportion of type A behavior, the scores of TH+CH, CH, consignation, anxiety, depression of intervention group were lower than those of pre-intervention. The scores of confronce, attributional style and psychosomatic function of intervention group were much higher than those of pre-intervention. The score of avoidance of control group was lower than that of pre-intervention. The score of optimism of control group was much higher than that of pre-intervention.We have got the conclusions as follows:1.The person with type A behavior represented a high proportion in hemiplegic stroke patients; the characteristic of behavior were high hostility and competitiveness; the coping style was confronce; the characteristic of emotion expression was anger.2.There were obvious changes in the characteristic of behavior and coping style after morbidity: The feature of high hostility and competitiveness declined obviously; it had changed from confronce to consignation and avoidance for coping style; the emotion expression had changed from anger to calmness or depression.3.The improving of behavior and coping style after morbidity could contribute to the rehabilitation of psychosomatic function.4.The most effective factor with anxiety, depression, QOL, somatic function was CH. 5.Not only the intervention schema improved the behavior and coping style, but also accelerated the rehabilitation of psychosomatic function. These methods could be applied in clinical practice.更多还原