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2018, 01, v.32 7-14
正念减压法对创伤后应激障碍患者干预效果的meta分析
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目的:系统评价正念减压(MBSR)对创伤后应激障碍(PTSD)患者的干预效果。方法:计算机检索Cochrane Library、Pubmed、MEDLINE、Embase、Web of Science、中国生物医学文献服务系统(CBM)、中国学术期刊全文数据库(CNKI)、万方数据库中MBSR对PTSD患者干预效果的相关研究,包括随机对照研究和自身前后对照研究,由2名研究者对纳入研究的质量进行评价和资料提取,采用RevMan5.3和Stata12.0软件进行统计学分析。结果:最终纳入文献8篇,其中随机对照研究4篇(纳入患者255人),自身前后对照研究4篇(纳入患者152人)。Meta分析结果显示,较常规干预措施,MBSR对患者PTSD症状有明显改善作用[SMD=-0.53,95%CI(-0.87~-0.19),P<0.05];自身前后干预效果评价表明,干预后患者PTSD症状较干预前明显改善[SMD=-1.95,95%CI(-2.84~-1.07),P<0.01]。患者干预后与随访过程中PTSD症状无明显变化[SMD=-0.26,95%CI(-0.770.26),P>0.05]。结论:正念减压能有效改善患者创伤后应激障碍,且干预效果比较稳定。

Abstract:

Objective: To systematically examine the efficacy of mindfulness-based stress reduction( MBSR)for post-traumatic stress disorder( PTSD). Methods: A systematic literature search was performed in multiple databases,including Cochrane Library,Pubmed,MEDLINE,Embase,Web of Science,CBM,CNKI,WanFang Database.Paper inclusion criteria were confined to intervention trials of MBSR conducted in patients with PTSD. Revman5. 3 and Stata12. 0 was used to get pooled results. Results: A total of 8 studies were included,4 randomized controlled trials( including 255 patients with PTSD) and 4 self-controlled studies( including 152 patients with PTSD). Comparing to control groups,MBSR groups resulted in statistically significant improvements on symptoms of PTSD [SMD =-0. 53,95%CI(-0. 87--0. 19),P < 0. 05]. The symptoms of PTSD after the intervention was improved [SMD =-1. 95,95% CI(-2. 84--1. 07),P < 0. 01]. There was no statistically significant difference between the data of follow-up and post-intervention [SMD =-0. 26,95% CI(-0. 77-0. 26),P >0. 05]. Conclusion: It suggests that the mindfulness-based stress reduction( MBSR) may be effective in reducing symptoms of post-traumatic stress disorder and have stable short-term effects.

参考文献

[1]Breslau N.Epidemiologic studies of trauma,posttraumatic stress disorder,and other psychiatric disorders[J].Can J Psychiatry,2002,47(10):923-929.

[2]梁瑞媚,范淑群,江丽娇,等.儿童青少年癌症患者创伤后应激障碍与生活质量相关性的研究[J].中国实用护理杂志,2014,30(16):8-11.

[3]Wilson JZ,M arin D,M axw ell K,et al.Association of posttraumatic grow th and illness-related burden w ith psychosocial factors of patient,family,and provider in pediatric cancer survivors[J].J Traum Stress,2016,29(5):448-456.

[4]M adsen T,Andersen SB,Karstoft KI.Are post-traumatic stress symptoms related to mental health service use?A prospective study of Danish soldiers deployed to Afghanistan[J].J Clin Psychiatry,2016,77(10):e1226-e1232.

[5]Post LM,Feeny NC,Zoellner LA,et al.Post-traumatic stress disorder and depression co-occurrence:structural relations among disorder constructs and trait and symptom dimensions[J].Psychol Psychother,2015,89(4):418-434.

[6]戴文杰,陈龙,谭红专等.社会支持及应对方式对洪灾PTSD慢性化的影响[J].中华流行病学杂志,2016,37(2):214-217.

[7]Zhang XG,Zhang H,Liang XL,et al.Epigenetic mechanism of maternal post-traumatic stress disorder in delayed rat offspring development:dysregulation of methylation and gene expression[J].Genet M ol Res,2016,15(3).doi:10.4238/gmr.15039009.

[8]Rusch HL,Shvil E,Szanton SL,et al.Determinants of psychological resistance and recovery among w omen exposed to assaultive trauma[J].Brain Behav,2015,5(4):651-683.

[9]Bishop SR.What do w e really know about mindfulness-based stress reduction[J].Psychosom M ed,2002,64(1):71-83.

[10]Brefczynski-Lew is JA,Lutz A,Schaefer HS,et al.Neural correlates of attentional expertise in long-term meditation practitioners[J].Proc Natl Acad Sci U S A,2007,104(27):11483-11488.

[11]余媚,严由伟,林荣茂,等.正念减压疗法的神经机制及应用研究述评[J].福建师范大学学报(哲学社会科学版),2012,177(6):215-222.

[12]Lazar SW,Kerr CE,Wasserman RH,et al.M editation experience is associated w ith increased cortical thickness[J].Neuro Report,2005,16(17):1893-1897.

[13]Lamothe M,Rondeau E,M alboeuf-Hurtubise C,et al.Outcomes of M BSR or M BSR-based interventions in health care providers:a systematic review w ith a focus on empathy and emotional competencies[J].Complement Ther M ed,2016,24:19-28.doi:10.1016/j.ctim.2015.11.001.

[14]Higgins JPT,Green S.Cochrane handbook for systematic review s of interventions version 5.1.0[M].Hoboken,NJ:Wiley-Blackw ell,2011.

[15]Li J,Yuan H,Chen Y,et al.A meta-analysis of dehydroepiandrosterone supplementation among w omen w ith diminished ovarian reserve undergoing in vitro fertilization or intracytoplasmic sperm injection[J].Int J Gynecol Obst,2015,131(3):240-245.

[16]Ramsay C,Brow n E,Hartman G,et al.Room for improvement:a systematic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing[J].J Antimicrob Chemother,2003,52(5):764-771.

[17]Kearney DJ,Simpson TL,M alte CA,et al.M indfulness-based stress reduction in addition to usual care is associated w ith improvements in pain,fatigue,and cognitive failures among veterans w ith gulf w ar illness[J].Am J M ed,2016,129(2):204-214.

[18]Polusny M A,Erbes CR,Thuras P,et al.M indfulness-based stress reduction for posttraumatic stress disorder among veterans:a randomized clinical trial[J].JAM A,2015,314(5):456-465.

[19]Kearney DJ,M c Dermott K,M alte C,et al.Effects of participation in a mindfulness program for veterans w ith posttraumatic stress disorder:a randomized controlled pilot study[J].J Clin Psychol,2013,69(1):14-27.

[20]King AP,Erickson TM,Giardino ND,et al.A pilot study of group mindfulness‐based cognitive therapy(M BCT)for combat veterans w ith posttraumatic stress disorder(PTSD)[J].Depress Anxiety,2013,30(7):638-645.

[21]Kearney DJ,M c Dermott K,M alte C,et al.Association of participation in a mindfulness program w ith measures of PTSD,depression and quality of life in a veteran sample[J].J Clin Psychol,2012,68(1):101-116.

[22]Goldsmith RE,Gerhart JI,Chesney SA,et al.M indfulness-based stress reduction for posttraumatic stress symptoms building acceptance and decreasing shame[J].J Evid Based complementary Altern M ed,2014,19(4):227-234.

[23]Earley M D,Chesney M A,Frye J,et al.M indfulness intervention for child abuse survivors:a 2.5-year follow-up[J].J Clin Psychol,2014,70(10):933-941.

[24]Kimbrough E,M agyari T,Langenberg P,et al.M indfulness intervention for child abuse survivors[J].J Clin Psychol,2010,66(1):17-33.

[25]Strauss C,Cavanagh K,Oliver A,et al.M indfulness-based interventions for people diagnosed w ith a current episode of an anxiety or depressive disorder:a meta-analysis of randomised controlled trials[J].PLo S One,2014,9(4):e96110.

[26]Spijkerman M P,Pots WT,Bohlmeijer ET.Effectiveness of online mindfulness-based interventions in improving mental health:a review and meta-analysis of randomised controlled trials[J].Clin Psychol Rev,2016,45:102-114.doi:10.1016/j.cpr.2016.03.009.

[27]Gu J,Strauss C,Bond R,et al.How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and w ellbeing?A systematic review and meta-analysis of mediation studies[J].Clin Psychol Rev,2015,37:1-12.doi:10.1016/j.cpr.2015.01.006.

[28]Kangas M,Bovbjerg DH,M ontgomery GH.Cancer-related fatigue:a systematic and meta-analytic review of non-pharmacological therapies for cancer patients[J].Psychol Bulln,2008,134(5):700-741.

[29]Abbott RA,Whear R,Rodgers LR,et al.Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease:a systematic review and meta-analysis of randomised controlled trials[J].J Psychosom Res,2014,76(5):341-351.

[30]Cramer H,Lauche R,Paul A,et al.M indfulness-based stress reduction for breast cancer-a systematic review and meta-analysis[J].Curr Oncol,2012,19(5):343-352.

[31]Bradley R,Greene J,Russ E,et al.A multidimensional meta-analysis of psychotherapy for PTSD[J].Am J Psychiatry,2005,162(2):214-227.

[32]Sloan DM,Feinstein BA,Gallagher M W,et al.Efficacy of group treatment for posttraumatic stress disorder symptoms:A meta-analysis[J].Psychol Trauma,2013,5(2):176-183.

基本信息:

中图分类号:R749.5

引用信息:

[1]董婷婷,张成帅,张志强,等.正念减压法对创伤后应激障碍患者干预效果的meta分析[J].中国心理卫生杂志,2018,32(01):7-14.

发布时间:

2018-01-10

出版时间:

2018-01-10

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