A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients

OBJECTIVE: The objective of this study was to assess the effects of participation in a mindfulness meditation-based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients. METHODS: A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after giving informed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice. RESULTS: Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients' mean preintervention scores on dependent measures were equivalent between groups. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress. CONCLUSIONS: This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages. cancer, stress, mood, intervention, mindfulness.     

认知暴露疗法治疗创伤后应激障碍的研究

目的 探讨认知暴露疗法治疗创伤后应激障碍(PTSD)的效果.方法 连续病例20名被随机分成两组,一组采取药物干预,另一组采用认知暴露疗法结合药物干预.疗效采用创伤后应激障碍症状清单量表(PCLS)、症状自评量表(SCL-90)、贝克抑郁问卷(BDI)、状态-特质焦虑问卷(STAI-Form Y)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)进行盲法评定.结果 药物治疗和结合治疗都在一定程度上改善了PTSD的症状,但是在再经历方面,结合治疗组下降稳定.其余各量表纵向效应明显.随访时用创伤后应激障碍症状清单量表(PCLS)进行测量,发现结合治疗组有两名被试已经不再符合PTSD诊断阶段,但是统计检验显示两治疗组之间并无差异.结论 认知暴露疗法有助于PTSD患者的心理康复.     

Anxiety is a good indicator for somatic symptom reduction through behavioral medicine intervention in a mind/body medicine clinic

BACKGROUND: This study examined the effect of anxiety on symptom reduction through a behavioral medicine intervention in a Mind/Body Medicine Clinic. METHOD: Participants were 1,312 outpatients attending a 10-week behavioral medicine intervention which included training in the relaxation response, cognitive restructuring, exercise and nutrition. All of the patients had physical symptoms and were referred to the clinic by their physician. The Medical Symptom Checklist (12 major symptoms), Symptom Checklist 90 Revised (SCL-90R), Stress Perception Scale and the Health-Promoting Lifestyle Profile were administered before and after the program. RESULTS: Of the sample, 1,012 patients completed the program, and 911 completed the posttreatment assessment. Self-reported frequency of medical symptoms, degree of discomfort and interference with daily activities were significantly reduced as a result of the program. Anxiety and other psychological distress as measured by the SCL-90R and stress perception scales also showed significant reductions. Furthermore, health-promoting lifestyle functioning significantly improved. High levels of pretreatment anxiety predicted a decrease in the total number of medical symptoms endorsed. CONCLUSIONS: Behavioral medicine interventions are effective in reducing medical symptoms coinciding with improvement in anxiety. High anxiety at program entry may predict better outcome.     

信息损伤的佐证——来自职业暴露领域的证据

目的通过职业暴露前后人员的心理健康状况比较,探讨职业暴露信息对个体心理健康的影响,为信息损伤理论提供实证研究证据及相应干预依据。方法对放射医学专业本科生接触放射线前重点强调暴露源危害性．运用症状自评量表、焦虑自评量表和抑郁自评量表,比较25名受试者暴露前和暴露后（暴露1周）的心理健康状况。结果SCL-90各项得分均高于职业暴露后,其中躯体化、强迫、人际关系、抑郁、偏执、精神病性、阳性项目数、总分均达到统计学显著水平（P〈0．05）．但焦虑、敌时和恐怖等因子未达到统计学显著水平（P〉0．05）。暴露前个体SDS抑郁指数得分和SAS得分均显著高于暴露后。结论暴露源危害性信息影响了个体的心理健康水平,产生了信息损伤,对职业暴露个体在暴露前的专业教育和心理教育非常必要,同时暴露期间的心理干预不容忽视。     

Am I (hyper)aroused or anxious? Clinical significance of pre‐sleep somatic arousal in young adults

Self‐reported somatic arousal remains a challenging clinical construct, particularly because only a subset of patients report symptoms such as racing heart, palpitations or increased body temperature interfering with their sleep. It is unclear whether self‐reported somatic arousal is a marker of hyperarousal or co‐morbid clinical anxiety in individuals with insomnia. Participants included 196 young adults aged 20.2 ± 1.0 years old who were predominantly females (75%). About 39% of the sample reported subthreshold insomnia, and about 8% reported clinically significant insomnia, based on their Insomnia Severity Index. Participants completed the Pre‐Sleep Arousal Scale, Beck Anxiety Inventory, Beck Depression Inventory, Arousal Predisposition Scale, and Ford Insomnia Response to Stress Test. Multivariable stepwise regression assessed which factors were independently associated with pre‐sleep cognitive (Pre‐Sleep Arousal Scale‐Cognitive) and somatic (Pre‐Sleep Arousal Scale‐Somatic) arousal. Receiver‐operating characteristic analysis assessed the predictive value to identify clinically significant anxiety (Beck Anxiety Inventory ≥ 20), insomnia (Insomnia Severity Index ≥ 15) and arousability (Arousal Predisposition Scale ≥ 32). Beck Anxiety Inventory (β = 0.42) was the best single correlate of Pre‐Sleep Arousal Scale‐Somatic, while Insomnia Severity Index (β = 0.33) was of Pre‐Sleep Arousal Scale‐Cognitive. A Pre‐Sleep Arousal Scale‐Somatic score of 12 or more identified those with clinically significant anxiety with 65% specificity and 65% sensitivity, while a cut‐off score of 14 increased its sensitivity (86%). Self‐reported pre‐sleep somatic arousal may be an index of co‐morbid clinical anxiety in individuals with insomnia. These findings aid clinicians with assessment and treatment, particularly in the absence of clinical guidelines indicating when somatically focused relaxation techniques should be included as part of multicomponent cognitive behavioural treatment of insomnia.     

Effectiveness of a psychosocial counselling intervention for first-time IVF couples: a randomized controlled trial

BACKGROUND: The objective of this study was to evaluate a psychosocial counselling intervention for first-time IVF couples. In this article the results on women's distress are presented. METHODS: Two hundred sixty-five couples admitted to an IVF treatment programme at the Erasmus MC were asked to participate in this study. Eighty-four couples agreed and were randomized according to a computer-generated random-numbers table into either a routine-care control group or an intervention group. The intervention consisted of three sessions with a social worker trained in Experiential Psychosocial Therapy: one before, one during and one after the first IVF cycle. Distress was measured daily during treatment by the Daily Record Keeping Chart. Depression and anxiety were measured before and after treatment by the Hospital Anxiety and Depression Scale. RESULTS: No significant group differences were found. CONCLUSIONS: The results of this study do not support the implementation of our counselling intervention for all first-time IVF couples. The low response rate suggests that there is little perceived need for psychosocial counselling among couples during a first IVF treatment cycle.     

Does rapid genetic counseling and testing in newly diagnosed breast cancer patients cause additional psychosocial distress? results from a randomized clinical trial

PurposeFemale breast cancer patients carrying a BRCA1/2 mutation have an increased risk of second primary breast cancer. Rapid genetic counseling and testing (RGCT) before surgery may influence choice of primary surgical treatment. In this article, we report on the psychosocial impact of RGCT.MethodsNewly diagnosed breast cancer patients at risk for carrying a BRCA1/2 mutation were randomized to an intervention group (offer of RGCT) or a usual care control group (ratio 2:1). Psychosocial impact and quality of life were assessed with the Impact of Events Scale, Hospital Anxiety and Depression Scale, Cancer Worry Scale, and the EORTC QLQ-C30 and QLQ-BR23. Assessments took place at study entry and at 6- and 12-month follow-up visits.ResultsBetween 2008 and 2010, 265 patients were recruited into the study. Completeness of follow-up data was more than 90%. Of the 178 women in the intervention group, 177 had genetic counseling, of whom 71 (40%) had rapid DNA testing and 59 (33%) received test results before surgery. Intention-to-treat and per-protocol analyses showed no statistically significant differences between groups over time in any of the psychosocial outcomes.ConclusionsIn this study, RGCT in newly diagnosed breast cancer patients did not have any measurable adverse psychosocial effects.     

焦点解决取向团体辅导对血液透析患者负面情绪及医学应对方式的干预效果

目的:探究焦点解决取向团体辅导对血液透析患者焦虑、抑郁情绪和医学应对方式的影响。方法:将60名血液透析患者分为对照组(n=30)和干预组(n=30),对照组接受常规护理,干预组在此基础上接受为期五周的焦点解决取向团体辅导。干预开始前和结束后,分别采用焦虑自评量表、抑郁自评量表、医学应对方式问卷评定被试情绪及医学应对方式。结果:干预后,干预组的抑郁和焦虑水平较同期对照组显著降低。在医学应对方面,干预后,干预组的面对水平较同期对照组显著提升;屈服水平较同期对照组显著下降。结论:焦点解决取向团体辅导能降低血液透析患者的焦虑、抑郁情绪,改善其医学应对方式。     

Perceived control and psychological distress in women with breast cancer: a longitudinal study

The relationship between perceived control and psychological distress in cancer patients has been widely studied, but longitudinal designs are scarce. The aim of this study was to examine whether perceived control could predict changes in the evolution of psychological distress in breast cancer patients at stages I or II. One hundred and one women were assessed on five occasions: one week after surgery, and again 1, 3, 6 and 12 months later, using the Mental Adjustment to Cancer (MAC) Scale, a Self-Efficacy Scale, the Personal Competence Scale, the Hospital Anxiety and Depression Scale (HADS), the Profile of Mood Sates (POMS), and the EORTC questionnaire of quality of life. Latent growth curve (LGC) model analysis was used to test the relationship between perceived control and psychological distress in a longitudinal, 1-year study. The results showed that perceived control increases linearly and that distress also decreases linearly. Moreover, the evolution of distress can be predicted from the initial value and the rate of change of perceived control. This close relationship between perceived control and psychological distress was found to be independent of the evolution of the physical state. These findings suggest that perceived control could be used as an early predictor of psychological adjustment to illness.     

心理干预对改善青光眼患者心理状况的效果

目的探讨心理干预对改善青光眼患者心理状况的效果。方法采用症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对38例原发性闭角型青光眼患者进行调查,与国内常模相比较,并对其进行为期6周的心理干预。结果青光眼患者的SCL-90中躯体化症状、强迫、人际关系、抑郁、焦虑、敌对、精神病性症状因子、SAS和SDS的评分显著高于全国常模(t=2.32,2.26,2.43,2.41,2.35,2.12,2.10,2.59,2.63;P0.05),心理干预后,青光眼患者的SCL-90中躯体化症状、强迫、人际关系、抑郁、焦虑、敌对、精神病性症状因子、SAS和SDS的评分较干预前有显著性降低(t=2.39,2.35,2.31,2.52,2.56,2.20,2.28,2.48,2.50;P0.05)。结论青光眼患者的心理问题状况较为严重,心理干预可有效改善患者的心理状况。     

认知干预对脊柱侧弯矫形术患者焦虑的影响

目的探讨认知干预对脊柱侧弯矫形术患者焦虑心理的影响。方法选取我院2010年1月-2013年3月行脊柱侧弯矫形术患者68例,随机分为对照组和干预组各34例。对照组实施常规护理;干预组在常规护理基础上实施认知干预。运用焦虑自评量表(SAS)对两组患者于入院时、术前1天、术后2天及术后2周进行焦虑状态评估。结果对照组术前1天和术后2天SAS得分均较入院时明显升高(t=5.79,6.36;P0.05),2周后患者SAS得分较术前1天和术后2天显著下降(t=-6.61,-7.17;P0.05)。而干预组术前1天和术后2天SAS得分较入院时无显著差异(t=1.85,1.61;P0.05)。入院时干预组和对照组SAS得分无显著差异(t=-0.31,P0.05),而干预组术前1天、术后2天以及术后2周SAS得分均较对照组明显降低(t=-3.60,-4.26,-2.77;P0.05)。结论脊柱侧弯矫形术患者围手术期存在明显的焦虑,积极有效的认知干预可明显减轻患者围手术期的焦虑状态。     

Key determinants of the MMPI-PTSD subscale: treatment considerations

Seventy-five "in country" Vietnam combat psychiatric inpatients were given a battery of measures upon admission to the medical center. These included the MMPI, VETS Adjustment Scale, State-Trait Anxiety Scale, Rotter Locus of Control, Profile of Mood Scale, and a variation of the Figley Stress Scale that measures current stress. Post-traumatic stress disorder (PTSD) was determined by the MMPI-PTSD subscale. Ten of the battery variables were used as predictors for a multiple regression analysis on the MMPI-PTSD subscale. Results yielded a multiple R of .89 for two predictors, Figley Stress Scale and Rotter Locus of Control (external). Patients with PTSD, therefore, suffer most from perceived and experienced current stressors and a low sense of control. Arguments are made for more present-centered and interpersonal strategies in the treatment of PTSD combat veterans.     

Cardiac rehabilitation for the treatment of women with chest pain and normal coronary arteries

OBJECTIVE: To explore cardiac rehabilitation (CR) as a treatment for psychological and physiological morbidity in women with chest pain and normal coronary arteries (cardiac syndrome X). DESIGN: Sixty-four women aged 57.3+/-8.6 years (mean +/- SD) with cardiac syndrome X were randomly assigned to an 8-week phase III CR exercise program or symptom monitoring control. All women completed the Hospital Anxiety and Depression Scale, Health Anxiety Questionnaire, and Short Form-36 before and after intervention and at the 8-week follow-up. CR patients underwent physical assessment before and after CR. RESULTS: After CR, patients demonstrated improved symptom severity (2.0+/-0.8 vs 1.26+/-1.1, P=0.009), Hospital Anxiety and Depression Scale depression score (8.0+/-3.4 vs 6.4+/-3.1, P=0.04), total Health Anxiety Questionnaire score (12.0+/-5.5 vs 9.5+/-6.0, P=0.008), health worry (4.5+/-3.1 vs 3.52+/-2.4, P=0.025) and interference (2.4+/-1.8 vs 1.6+/-1.8, P=0.004), SF-36 physical functioning (53.1+/-20.4 vs 62.3+/-23.9, P = 0.006), energy (36.3+/-20.7 vs 49.8+/-19.1, P<0.001), pain (49.9+/-20.7 vs 58.1+/-22.9, P=0.028), and general health (48.8+/-17.9 vs 57.6+/-17.0, P=0.01) not found among the control women. Improvements were maintained at follow-up. CR patients showed significant improvements in Shuttle Walk Test performance (326.8+/-111.0 vs 423.6+/-133.2 m, P<0.001), diastolic blood pressure (84.7+/-9.4 vs 79.7+/-7.3 mm Hg, P=0.007), and body mass index (29.1+/-6.0 vs 28.4+/-6.17 kg/m2, P=0.003). CONCLUSIONS: An 8-week phase III CR program improves exercise tolerance, quality of life, psychological morbidity, symptom severity, and cardiovascular risk factors in women with cardiac syndrome X.     

奥拉西坦改善阿尔茨海默病患者神经功能与记忆功能的综合护理效果

目的:探讨综合护理方法在阿尔茨海默病患者奥拉西坦治疗中的应用效果.方法:选取2013年5月至2017年1月哈尔滨医科大学附属第二医院收治的86例阿尔茨海默病患者作为研究对象,按入院时间将其分为对照组(2013年5月至2015年5月)和干预组(2015年6月至2017年1月),每组43例.所有患者予以阿尔茨海默病常规基础联合奥拉西坦等药物对症治疗,对照组予以常规临床护理,干预组患者予以综合护理模式干预,两组均干预两周.干预结束后比较两组神经功能、记忆功能、生活质量和抑郁情况,以及患者/患者家属对护理的满意度.结果:干预后两组美国国立卫生研究院卒中神经功能缺损评分(National Institute of Health stroke scale,NIHSS)较干预前明显降低,而韦氏记忆测试修订版(Wechsler Memory Scale-Revised,WMS-R)评分均较干预前明显升高,差异有统计学意义(P<0.05),但两组干预后比较,差异无统计学意义(P>0.05);两组干预后其日常生活自理能力表(Activity of Daily Living Scale,ADL)和汉密尔顿抑郁量表(Hamilton Anxiety Scale,HAMA)评分均较干预前降低,且干预组降低程度明显大于对照组,差异有统计学意义(P<0.05);干预组护理总满意度与对照组比较差异有统计学意义(97.67％vs 83.72％,P<0.05).结论:综合性护理可明显提高予以奥拉西坦治疗的阿尔茨海默病患者的生活质量,并降低其抑郁程度,同时更易于被患者及家属所接受,可作为临床上阿尔茨海默病患者的优选护理模式.     

Somatization and symptom reduction through a behavioral medicine intervention in a mind/body medicine clinic.

The authors assessed data from 1,148 outpatients in a 10-week medical symptom reduction program to determine the effectiveness of a behavioral medicine intervention among somatizing patients. The program included instruction in the relaxation response, cognitive restructuring, nutrition, and exercise. Before and after the intervention, the patients were evaluated on the Symptom Checklist-90 Revised (SCL-90R), the Medical Symptom Checklist, and the Stress Perception Scale. They were divided into high- and low-somatizing groups on the basis of the pretreatment SCL-90R somatization scale. At the end of the program, physical and psychological symptoms on the Medical Symptom Checklist and the SCL-90R were significantly reduced in both groups, with the reductions greater in the high-somatizing group. Improvements in stress perception were about the same in both groups, but the absence of an untreated control group precluded estimates of how much the improvements resulted from the behavioral medicine intervention and how much from natural healing over time.     

A validation study of the Cardiac Depression Scale (CDS) in a UK population

Objectives: This study was designed to validate the Cardiac Depression Scale (CDS) in a UK cardiac population. Method: A battery of questionnaires (the Medical Outcomes Study Short‐Form 36 [SF‐36] Health Survey, the Beck Depression Inventory [BDI], the Hospital Anxiety and Depression Scale [HADS] and the Cardiac Depression Scale [CDS]) was mailed to 487 individuals with coronary heart disease (CHD) recruited from cardiac support groups. The process was repeated on a subsample of 80 participants four‐six weeks later for the purpose of test‐retest analysis. Results: The response rate from the first administration was 81% and from the test‐retest subsample 54%. Factor analysis revealed a one‐factor solution with a high internal reliability (Cronbach's α = 0.93) and an acceptable test‐retest reliability (0.79). Concurrent validation against the SF‐36, BDI and HADS demonstrated strong correlations. Conclusions: The CDS is both a reliable and sensitive instrument for measuring depression in cardiac patients.     

动物辅助治疗对大学生社交焦虑障碍的影响

目的 考察动物辅助治疗(Animal-assisted Therapy,AAT)对于大学生社交焦虑干预的有效性.方法 从某医科大学大一新生中征集喜爱狗志愿者492人,使用社交焦虑问卷(LSAS)和DSM-Ⅳ诊断标准筛查符合社交焦虑诊断标准的被试20人,随机抽取10人组成实验组接受10次动物辅助治疗,10人作为控制组不进...     

心理干预在胃癌患者围术期的应用研究

目的:探讨心理干预对胃癌患者围手术期的焦虑和抑郁的护理效果。方法:将80例行胃癌的手术患者随机分为观察组40例和对照组40例,观察组采用心理护理,对照组采用常规护理方法,患者均采用抑郁(SDS)和焦虑自评量表(SAS)进行评价,并比较二者的护理效果。结果:观察组抑郁和焦虑指数在治疗后比治疗前显著下降(P<0.01),而对照组治疗后比治疗前抑郁和焦虑指数下降不明显(P>0.05),治疗后对照组的两项指数均明显高于观察组(P<0.01)。结论:对胃癌患者围术期进行心理干预,可以有效降低患者的抑郁和焦虑程度,值得临床推广应用。     

Emotional, cognitive, and behavioral characteristics of medical outpatients: a preliminary analysis

The authors examined the relationship among emotional, cognitive, and behavioral factors in 65 new outpatients attending neurology and cardiology clinics. The patients completed the Hospital Anxiety and Depression Scale, the Illness Perception Questionnaire, the Somatosensory Amplification Scale, the Private Body Consciousness Scale, and the Health Anxiety Questionnaire. A principal component factor analysis revealed two factors, somatosensory amplification/anxiety and depression/pessimism, that together accounted for 44% of the variance. The factors the authors identified may be useful as a basis for understanding different patterns of illness behavior. The use of these factors may help to rationalize and refine the large number of existing measures and simplify the assessment process, as well as contributing to the development of treatment interventions.     

认知团体心理治疗干预社区慢性精神分裂症患者家庭照料者疗效

目的:探索认知团体心理治疗干预慢性精神分裂症家属心理精神状况的实际效果,为提升家属心理健康水平改善家庭康复成效提供理论依据。方法:通过在常规随访、康复指导基础上结合认知团体心理治疗的运用,以焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活满意度指数A量表(LSIA)、家庭负担会谈量表(FBS)、社会支持评定量表(SSRS)、亲属应激量表(RSS)等评估治疗对家庭照料者的影响,运用SPSS 13.0统计软件分析量表结果。结果:认知团体心理治疗干预后,干预组与对照组在SAS、SDS、LSIA以及SSRS的主观支持、支持利用度及总分因子中出现显著统计学差异(t/t'=-2.498,-3.675,2.762,2.835,4.370,3.624;P0.05),且在SAS、SDS量表因子中干预组得分低于对照组,在LSIA、SSRS量表因子中干预组得分高于对照组。干预前后,干预组在SAS、SDS、LSIA、SSRS、RSS上差异有统计学意义(t/t'=2.810,2.892,-2.385,-3.089,2.011;P0.05)结论:认知团体心理治疗能作为社区慢性精神分裂症患者家庭照料者社会支持系统的补充,显著减少其焦虑、抑郁情绪,提升其生活满意度水平。干预能通过改善照料者心理健康状况,促进其家庭康复氛围营造,使患者情绪趋于稳定,对缓解家属心理应激具有一定作用。