网络化接纳承诺疗法干预癌症患者身心症状：元分析、研发和效果研究

【作者】 张涛；

【导师】 任志洪；

【作者基本信息】 华中师范大学 ， 心理学， 2023， 硕士

【摘要】 癌症已成为日益严重的全球公共卫生问题。癌症患者在诊断和治疗过程中会出现明显的心理困扰和躯体症状,如抑郁、焦虑、疲劳、疼痛和睡眠障碍。这些症状会显著影响癌症患者的日常功能和癌症治疗过程,并有可能降低患者的生活质量和存活率。因此,提供有效的干预措施来缓解癌症患者的身心症状是至关重要的。在众多干预措施中,网络化接纳承诺疗法(Internet-based Acceptance and Commitment Therapy,iACT)被认为是一种有希望缓解癌症患者身心症状的疗法,越来越受到研究者和实践者所关注。然而网络化接纳承诺疗法对于癌症患者的干预在国内仍处于起步阶段。因此,本研究综合地使用了元分析和随机对照试验等方法,开展网络化接纳承诺疗法干预癌症病人的身心症状的研究,首先确定网络心理治疗干预癌症患者的有效性和影响因素,并进一步开发移动化网络化接纳承诺疗法小程序,检验其干预癌症病人身心症状的可接受性、可行性和有效性。研究1旨在为网络化心理干预对癌症患者的身心症状的效果提供全面的证据,并探究网络化干预癌症患者的影响因素,为网络化心理干预的开发和进一步研究奠定基础。研究一采用系统综述和元分析的方法,基于9个数据库的检索结果进行文献筛选,共纳入68项网络化心理疗法干预癌症患者的临床随机对照试验(Randomized Controlled Trials,RCTs),包含10797名癌症患者。元分析结果表明,网络化心理干预能够显著缓解癌症患者的抑郁(g=-0.26,95%CI:[-0.4;-0.06],p<0.05)、焦虑(g=-0.37,95%CI:[-0.67,-0.08],p<0.05)、疲劳(g=-0.25,95%CI:[-0.46,-0.03],p<0.05)、睡眠(g=-0.41,95%CI:[-0.66,-0.16],p<0.01)和生活质量(g=0.16,95%CI:[0.03,0.28],p<0.05),但在对疼痛的缓解无显著效果(g=-0.11,95%CI:[-0.26,0.04],p>0.05)。亚组分析结果显示,干预形式显著调节了对于焦虑的干预效果(p=0.001),而国家显著调节了干预对疲劳的效果(p=0.04),治疗师的指导和支持调节了干预效果对疼痛(p=0.04)和生活质量的效果(p=0.001),干预时长和干预单元数对干预效果无显著影响(ps>0.05)。研究2旨在探讨网络化接纳承诺疗法干预癌症病人身心症状的可行性、可接受性和有效性。在研究1基础上,研究2首先开发了基于接纳承诺疗法的手机干预程序,用于干预癌症病人的身心症状。采用线上线下结合的方式对成年癌症患者进行招募,以1:1的比例将符合招募标准并签署知情同意书的患者随机分配到网络化接纳承诺干预组或常规治疗组。测量包括可接受性、可行性、癌症患者身心症状和生活质量。干预持续时间为2周,在随机分组前、干预中(1周后)和干预结束后(2周后)对所有参与者进行线上评估。共60名癌症患者被随机分配到网络化ACT组(n=30)或常规治疗组(n=30)。研究结果显示,研究的招募率为55.04%,保留率为70%,同时在接受ACT干预的患者中,63.33%完成了干预,所有患者对干预达到了中等以上的满意,因此本研究具有可行性和可接受性。此外,接受ACT的患者相对于对照组,其心理痛苦水平(F=7.391,p=0.001)、抑郁(F=7.504,p=0.001)、焦虑(F=6.941,p=0.002)和疲劳水平(F=4.218,p=0.020)显著降低,但疼痛、睡眠和总体生活质量变化不显著(ps>0.05)。综上,在临床实践中可以考虑将网络化心理干预作为一种可能和有效的补充手段,以更好地管理癌症患者的身心症状。在进行网络化心理干预开发时,可以添加治疗师的指导和支持的成分,并尽可能采用个体干预的形式以提高治疗效果;同时,可以对干预的数量和干预时间进行一定缩减,从而降低癌症患者的负担。其中,网络化接纳承诺疗法对于缓解癌症患者身心症状具有可行性和可接受性,并显示出初步的疗效,不过未来还需要进行更大规模的随机对照研究。更多还原

【Abstract】 Cancer has become an increasingly serious global public health problem.Cancer patients experience significant psychological distress and physical symptoms such as depression,anxiety,fatigue,pain,and sleep disturbances during diagnosis and treatment.These symptoms significantly affect the daily functioning and cancer treatment process of patients and may reduce their quality of life and survival rate.Therefore,providing effective interventions to alleviate the psychosomatic symptoms of cancer patients is crucial.Among numerous interventions,Internet-based Acceptance and Commitment Therapy(iACT)is considered a promising therapy to relieve the psychosomatic symptoms of cancer patients,and it is receiving increasing attention from researchers and practitioners.However,the intervention of iACT for cancer patients is still in its early stages in China.Therefore,this study comprehensively used meta-analysis and randomized controlled trials to investigate the intervention of iACT on the psychosomatic symptoms of cancer patients.First,it identified the effectiveness and influencing factors of internet psychological therapy interventions for cancer patients and further developed a mobile iACT app to test its acceptability,feasibility,and effectiveness in intervening the psychosomatic symptoms of cancer patients.Study 1 aims to provide comprehensive evidence of the effects of internet psychological interventions on the psychosomatic symptoms of cancer patients and explore the influencing factors of internet-based interventions for cancer patients,laying a foundation for the development and further research of internet psychological interventions.Study 1 used a systematic review and meta-analysis method,based on the screening results of 9 databases,including 68 clinical randomized controlled trials(RCTs)of internet psychological therapy interventions for cancer patients,involving 10,797 cancer patients.The meta-analysis results showed that internet psychological interventions can significantly alleviate the depression(g =-0.26,95% CI: [-0.4;-0.06],p < 0.05),anxiety(g =-0.37,95% CI: [-0.67,-0.08],p < 0.05),fatigue(g =-0.25,95%CI: [-0.46,-0.03],p < 0.05),sleep(g =-0.41,95% CI: [-0.66,-0.16],p < 0.01),and quality of life(g = 0.16,95% CI: [0.03,0.28],p < 0.05)of cancer patients,but it has no significant effect on pain relief(g =-0.11,95% CI: [-0.26,0.04],p > 0.05).Subgroup analysis results showed that the intervention format significantly moderated the intervention effect on anxiety(p = 0.001),while the country significantly moderated the intervention effect on fatigue(p = 0.04),and therapist guidance and support moderated the intervention effect on pain(p = 0.04)and quality of life(p = 0.001).Intervention duration and intervention unit had no significant effect on the intervention effect(ps >0.05).Study 2 aims to explore the feasibility,acceptability,and effectiveness of the Internet-based Acceptance and Commitment Therapy(ACT)intervention for addressing the physical and psychological symptoms of cancer patients.Based on Study 1,Study 2developed a smartphone intervention program using ACT to alleviate the symptoms of cancer patients.Adult cancer patients were recruited both online and offline,and those who met the inclusion criteria and provided informed consent were randomly assigned to either the networked ACT intervention group or the conventional treatment group in a 1:1ratio.Measurements included acceptability,feasibility,cancer patient physical and psychological symptoms,and quality of life.The intervention lasted for two weeks,and online assessments were conducted for all participants before randomization,during the intervention(one week after),and after the intervention(two weeks after).A total of 60 cancer patients were randomly assigned to the networked ACT group(n = 30)or the conventional treatment group(n = 30).The study results showed a recruitment rate of55.04% and a retention rate of 70%,while 63.33% of patients who received ACT intervention completed it,and all patients were moderately satisfied with the intervention,demonstrating feasibility and acceptability.In addition,patients who received ACT intervention had significantly lower levels of psychological distress(F = 7.391,p =0.001),depression(F = 7.504,p = 0.001),anxiety(F = 6.941,p = 0.002),and fatigue(F= 4.218,p = 0.020)compared to the control group,but changes in pain,sleep,and overall quality of life were not significant(ps > 0.05).In conclusion,networked psychological intervention can be considered as a possible and effective supplementary approach in clinical practice to better manage the physical and psychological symptoms of cancer patients.When developing networked psychological interventions,therapist guidance and support can be added,and individual interventions can be used as much as possible to improve treatment effectiveness.At the same time,the number and duration of interventions can be reduced to reduce the burden on cancer patients.Networked Acceptance and Commitment Therapy is feasible and acceptable for alleviating the physical and psychological symptoms of cancer patients and has shown preliminary efficacy,but larger randomized controlled trials are needed in the future.更多还原