网络化认知行为疗法在心理护理实践中的研究进展

阐述网络化认知行为疗法的理论、基本概念、优势和构成,综述网络化认知行为疗法在心理护理实践中的研究现状,为国内开展网络化认知行为疗法的研究提供参考。     

认知行为疗法对乳腺癌患者抑郁和生活质量的影响系统评价和Meta分析

目的系统评价认知行为疗法对改善乳腺癌患者抑郁症状、提高生活质量的效果。方法计算机检索Pub Med、CBM、维普、万方和CNKI等数据库。收集关于认知行为疗法对改善乳腺癌患者抑郁症状,提高其生活质量的随机对照试验。检索时限均为建库至2014年12月31日。由2名研究者按照纳入与排除标准筛选文献、提取资料并评价质量后,采用Rev Man 5.3进行Meta分析。结果共纳入9个研究、867例患者。纳入文献的质量等级均为B级。以抑郁为结局指标的漏斗图提示存在发表偏倚。Meta分析结果显示:认知行为疗法组与常规护理组抑郁和生活质量改善的差异有统计学意义[MD=-1.22,95%CI(-1.44,-1.00),P0.00001],[MD=-5.83,95%CI(-8.10,-3.56),P0.00001];[SMD=1.42,95%CI(1.09,1.75),P0.00001],[SMD=0.57,95%CI(0.23,0.92),P=0.001];描述性结果显示:认知行为疗法能够改善乳腺癌患者的生活质量。结论认知行为疗法可以改善乳腺癌患者的抑郁,提高其生活质量。     

认知行为疗法结合临床管理对改善乳腺癌患者术后抑郁焦虑情绪的疗效观察

目的观察认知行为疗法结合临床管理对改善乳腺癌患者术后抑郁焦虑情绪的效果。方法将符合条件的99例患者随机分为干预组(49例)和对照组(50例),干预组进行认知行为疗法结合临床管理的干预,对照组只进行临床管理。结果干预8周后,干预组HAMD-17量表评分与干预前的差值显著高于对照组相应的差值,持续到干预结束。干预第2、4周,干预组的HAMA-17量表评分与基线期差值显著高于对照组相应的差值。结论认知行为疗法结合临床管理改善乳腺癌患者术后负性情绪效果优于单一的临床管理。     

网络化认知行为疗法在肠易激综合征病人中应用的研究进展

综述网络化认知行为疗法的概念、网络化认知行为疗法在肠易激综合征病人中的应用情况，以期为国内更好地开展肠易激综合征病人的心理治疗提供指导。     

认知行为疗法对乳腺癌患者创伤后成长的影响

目的探讨认知行为疗法对乳腺癌患者创伤后成长的影响。方法将乳腺癌患者分为实验组和对照组各30例,对照组予以乳腺外科常规护理,实验组在此基础上给予认知疗法和行为干预。结果干预后实验组乳腺癌患者的创伤后成长各维度及总分、应对方式的面对和回避维度得分和心理一致感各维度得分及总分均高于对照组(P<0.01或P<0.05),屈服维度得分低于对照组(P<0.01)。结论对乳腺癌患者实施结合积极心理学的认知行为疗法,有利于提高患者的创伤后成长水平,促进患者的心理健康,改善患者的生活质量。     

认知行为疗法对2型糖尿病抑郁患者抑郁情绪的改善作用

本文对认知行为疗法对2型糖尿病抑郁患者抑郁情绪作用进行综述,依次介绍了认知行为疗法的概念,糖尿病和抑郁情绪的相关性,认知行为疗法在2型糖尿病抑郁患者抑郁情绪中的作用和应用方式及具体内容,以及认知行为疗法对2型糖尿病患者的评价标准和应用效果,从而为认知行为疗法改善2型糖尿病患者抑郁情绪提供一些思路。     

网络化认知行为疗法在进食障碍病人中的研究进展

对国外网络化认知行为疗法在进食障碍病人中的应用现状及其优势进行综述,为国内相关研究的开展提供参考。     

认知行为疗法联合睡眠干预护理在乳腺癌术后化疗患者中的应用研究

目的:研究分析对认知行为疗法联合睡眠护理干预对乳腺癌术后化疗患者的影响作用。方法:选取2016年1月至2017年1月间郑州大学附属洛阳中心医院收治的乳腺癌术后化疗患者100例,遵循无差异性随机的原则随机分为观察组和对照组,每组50例,对照组患者采用单纯放疗治疗,观察组患者采用认知行为疗法治疗,对比治疗效果。结果:观察组患者与对照组患者治疗总有效率分别为98.0%、60.0%,2组比较差异有统计学意义(P0.05)。观察组患者与对照组患者肿瘤直径、生命质量、睡眠质量、并发症发生率等各项指标组间差异显著,其中观察组较为优异,差异有统计学意义(P0.05)。结论:本次研究证明,对乳腺癌术后化疗患者采用认知行为疗法治疗有利于提高治疗质量,改善患者并发症发生情况,可作为临床首选治疗方法推广。     

认知行为疗法对乳腺癌术后化疗患者睡眠质量的影响

目的探讨认知行为疗法（渐进性放松训练联合刺激控制疗法）对改善乳腺癌术后患者睡眠质量的效果。方法采用随机对照研究,将56例乳腺癌术后化疗患者随机分为干预组和对照组各28例。对照组接受乳腺癌术后化疗患者的常规护理;干预组在此基础上,接受为期18周的认知行为治疗。干预前和干预结束后分别用匹兹堡睡眠质量指数问卷（Pittsburgh sleep quality index,PSQI）对两组患者进行评定。结果干预前两组患者PSQI各项得分和总分比较差异无统计学意义（P〉0．05）;干预后干预组患者PSQI量表总分及睡眠质量、入睡潜伏期、睡眠时问、睡眠效率、睡眠障碍、催眠药物、日间功能障碍因子分均低于对照组,差异有统计学意义（P〈0．01）。结论认知行为疗法能有效改善乳腺癌术后化疗患者的心理健康状况,提高患者睡眠质量。     

积极认知行为疗法在乳腺癌根治术围手术期患者中的应用

目的探讨积极认知行为疗法在乳腺癌根治术围手术期患者中的应用效果及对患者术后生活质量的影响。方法选择在某三甲医院乳腺外科就医、确诊为乳腺癌、需行乳腺癌根治术的68例患者作为研究对象,随机分为对照组和实验组各34例,对照组患者只接受乳腺癌围手术期的常规护理,实验组患者除接受与对照组患者相同的常规护理外,还由受过统一培训学习的医务社工及志愿者小组成员在术前对患者及其家属进行为期两天的积极认知行为疗法的干预,两组患者分别在术前两日填写医院焦虑抑郁量表(HADS)和术后两周再次填写HADS及癌症患者生存质量共性量表(QLQ-C30)。结果术前两组患者的焦虑抑郁水平差异无统计学意义(P0.05),术后干预组患者焦虑、抑郁得分均显著低于对照组,术后干预组患者的疲倦、疼痛、失眠、食欲丧失及总体健康状况得分与对照组比较差异有统计学意义(P0.01)。结论积极认知行为疗法在乳腺癌根治术围手术期患者中的应用有良好的效果,不仅有效降低了患者术后焦虑、抑郁水平,且提高了患者术后的生活质量。     

认知行为治疗在癌痛病人心理支持中的应用

[目的]探讨认知行为治疗在癌痛病人心理支持中的应用。[方法]对56例癌病病人通过换位思考法、教育引导法、医患互信法进行有针对性的认知行为治疗。[结果]经认知行为治疗，56例病人止痛有效率达96％，止痛效果和生活质量得到提高。[结论]认知行为治疗可消除癌痛病人的负性情绪，提高病人的止痛效果和生活质量。     

Evaluation of the effect of cognitive behavioral therapy on tocophobia: A systematic review and meta-analysis

Non-medical approaches including cognitive behavioral therapy (CBT) have been proposed for the management of tocophobia. A new method of performing CBT is through internet. The aim of this systematic review and meta-analysis was to evaluate the effect of internet-based and traditional CBT on tocophobia. A literature search was conducted on qualitative and quantitative articles from 2000 to 2019 in Pubmed, Scopus, Web of Science and Cochrane databases using search terms referring to tocophobia and CBT. Identified articles were screened in two steps; 1) title and abstract and 2) full text screening. The quality of the quantitative and qualitative studies was assessed using the quality criteria proposed by the Cochrane Collaboration and Jonna Briggs Institute (JBI) checklist respectively. Out of the 382 relevant studies, 9 studies were eligible for the review. A high level of heterogeneity was observed in the studies (I² = 94%, P < 0.001). The meta-analysis showed that both internet-based, and traditional CBT were effective in reducing tocophobia. CBT was more effective in interventions in the Middle Eastern compared to European countries. More than five CBT sessions could significantly reduce tocophobia. Healthcare providers and midwives should have basic knowledge on physiological interventions to reduce tocophobia.     

Exploring social cognitive theory constructs for promoting exercise among breast cancer patients

Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.     

Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis

Acceptance-based interventions such as mindfulness-based stress reduction program and acceptance and commitment therapy are alternative therapies for cognitive behavioral therapy for treating chronic pain patients. To assess the effects of acceptance-based interventions on patients with chronic pain, we conducted a systematic review and meta-analysis of controlled and noncontrolled studies reporting effects on mental and physical health of pain patients. All studies were rated for quality. Primary outcome measures were pain intensity and depression. Secondary outcomes were anxiety, physical wellbeing, and quality of life. Twenty-two studies (9 randomized controlled studies, 5 clinical controlled studies [without randomization] and 8 noncontrolled studies) were included, totaling 1235 patients with chronic pain. An effect size on pain of 0.37 was found for the controlled studies. The effect on depression was 0.32. The quality of the studies was not found to moderate the effects of acceptance-based interventions. The results suggest that at present mindfulness-based stress reduction program and acceptance and commitment therapy are not superior to cognitive behavioral therapy but can be good alternatives. More high-quality studies are needed. It is recommended to focus on therapies that integrate mindfulness and behavioral therapy.     

On-line information and support for supporters and carers of haematological cancer patients: is access an issue?

Purpose

This study aimed to assess levels of internet access, likelihood of using various sources of information or support, and sociodemographic characteristics related to high internet access among support persons of haematological cancer patients.

Methods

A cross-sectional sample of haematological cancer survivors was recruited via a state cancer registry in Australia. Participating survivors invited their support persons to complete a survey. Of the 268 survivors, 68% had a support person return a survey. Approximately 80% of support persons reported having internet access.

Results

Almost three quarters (74%) reported having ‘high’ access. Support persons reported their likelihood of using internet-based forms of information and support (59% and 26%, respectively) was lower than for other sources, including those delivered face-to-face (80% and 75%) or through print (87% and 70%). Participants who were older or had less education were less likely to report a high level of internet access or likelihood of using web-based sources.

Conclusions

The results demonstrate the need to continue to provide information and support via multiple modes. Support persons who potentially are more vulnerable due to age and lower education are the least likely to use internet-based options. Consequently, these groups may require alternatives, including face-to-face or print-based information and support.     

认知行为疗法对医学难以解释的躯体症状干预效果的Meta分析

目的评价认知行为疗法对医学难以解释的躯体症状的干预效果。方法计算机检索Cochrane图书馆、Pubmed、Embase、中文期刊全文数据库(CNKI)、万方、维普数据库中的随机对照实验,干预措施为认知行为疗法。严格质量评价后,采用RevMan5.4进行数据分析。使用标准化均数差计算试验的效应大小,并用I2检验评估样本的异质性。结果最终纳入9项研究,共计1035名研究对象。Meta分析结果显示,认知行为疗法可以缓解医学难以解释的躯体症状SMD=-0.33(n=1035,CI=-0.45-0.20),P<0.001。结论认知行为疗法能对医学难以解释的躯体症状产生有效干预。     

胃肠癌化疗患者对基于问题解决疗法的认知行为干预的体验

目的探索并分析胃肠癌化疗患者在进行基于问题解决疗法的认知行为干预后的体验及变化。方法便利抽样选取2015年7-12月在上海某三级甲等医院住院及门诊化疗的胃肠癌患者32人,实施基于问题解决疗法的认知行为干预。干预结束后采用半结构访谈法,电话访谈该组患者并录音转录,采用Colaizzie7步分析法进行资料整理分析。结果整理归纳后,析出5个主题:(1)转危为安,规划未来;(2)加油鼓励,重拾信心;(3)吐露心声,悬石落地;(4)摸出门路,步步解决问题;(5)敏感多虑,渴求帮助。结论基于问题解决疗法的认知行为干预可帮助患者建立合理认知、缓解负性情绪,形成积极应对方式;可形成6步程序化问题解决思维,提升理性问题解决能力;故应重视癌症患者的心理需求,促进癌症心理护理的专业化发展。     

癌症病人心理一致感干预措施及其效果的系统评价

目的:系统评价癌症病人心理一致感干预措施及其效果。方法:计算机检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普、万方、PubMed、the Cochrane Library、Web of Science、EBSCO等数据库中评价癌症病人心理一致感干预研究的随机对照试验,检索时限均为建库至2020年5月31日。由2名研究者独立进行文献筛选、质量评价以及资料提取,采用定性方法汇总纳入文献的干预措施及其效果。结果:最终纳入9项随机对照试验,涉及1090例病人。纳入文献的质量等级均为B级。干预措施中认知行为疗法3篇,正念减压疗法2篇,音乐疗法结合放松训练1篇,志愿者团队健康教育法1篇,基于平台的支持教育计划1篇,家属同步阶段性认知疗法1篇。7项研究结果显示,干预措施可提高病人心理一致感水平。结论:现有证据表明采取认知行为疗法、正念减压疗法、志愿者团队健康教育法、家属同步阶段性认知疗法均能提高癌症病人的心理一致感水平。     

基于网络的互动式健康教育对炎症性肠病患者疾病认知及自我管理行为的影响

目的 探讨基于网络的互动式健康教育对炎症性肠病患者知识水平和自我管理行为的影响。方法 选取2019年8月-2020年11月就诊于消化内科的113例炎症性肠病患者,按入院时间顺序将其分为对照组(57例)和干预组(56例)。对照组采用消化内科常规健康教育,干预组采用基于网络的互动式健康教育,比较2组干预前后的知识水平和自我管理行为能力。结果 干预6个月后,干预组一般知识、用药知识和并发症知识3个维度得分均高于对照组(P＜0.05);用药管理、饮食管理、疾病监测、情绪管理、生活管理和资源利用6个维度得分也高于对照组(P＜0.05)。结论 基于网络的互动式健康教育能有效提高患者的知识水平和自我管理行为能力。     

Cognitive Rehabilitation for Cognitive Dysfunction after Cancer and Cancer Treatment: Implications for Nursing Practice

ObjectiveTo provide an overview of cognitive rehabilitation approaches for cognitive dysfunction after cancer and cancer treatment.Data SourcesReview and synthesis of empirical articles.ConclusionCognitive rehabilitation approaches, including cognitive behavioral therapy and cognitive training, for cognitive dysfunction appear feasible to deliver, satisfactory to participants, and have shown promising results in cancer survivors. Future research is needed to address optimal dose, delivery method, access, cost, and the vulnerable aging cancer survivor population.Implications for Nursing PracticeOncology nurses must understand the available evidence and be able to provide information and options to cancer survivors to address cognitive changes after cancer.