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[自生训练在慢性躯体疾病患者心理矫正治疗中的有效性]

[The effectiveness of autogenic training in the psycho-corrective treatment of the patients presenting with chronic somatic diseases].

作者信息

Aivazyan T A, Zaitsev V P

机构信息

Russian Research Center of Medical Rehabilitation and Balneology, Moscow, Russia.

Moscow Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia.

出版信息

Vopr Kurortol Fizioter Lech Fiz Kult. 2018;95(3):11-15. doi: 10.17116/kurort201895311.

Abstract

BACKGROUND

The autogenic training (AT) is one of the most widely used methods for psychotherapy of patients suffering from chronic somatic diseases (CSD). A number of studies have demonstrated the improvement of the psychological status in the patients under the influence of autogenic training. However, up to the present time, both the mechanisms underlying the therapeutic effectiveness and the predictors of the AT effectiveness have remained to be poorly studied which hampers the development of differentiated indications for the application of this technique.

AIM

The objective of the present study was to estimate the effectiveness of AT and to identify the predictors of the outcomes of the treatment of patients presenting with chronic somatic diseases.

MATERIAL AND METHODS

The study included 325 patients with CSD who were examined with the use of the shortened multifactorial personality inventory (SMPI), the Spielberger State-Trait Anxiety Inventory (STAI), and the Beck depression inventory (BDI) scales. The patients were randomized into two groups. Group 1 (main) was comprised of 163 patients who underwent AT-based psychotherapy, group 2 (control) consisted of 162 patients who did not receive the psychotherapy. In order to identify the predictors of AT effectiveness, the patients of the main group were subdivided into two subgroups at the end of the study period: (a) including 128 patients whose psychologic status was normalized under psychotherapy and (b) containing 35 patients showing the improvement of their health status. The comparative analysis of the baseline characteristics of the patients belonging to each group was performed.

RESULTS

The study has demonstrated that by the end of the observation period the patients of the main group showed a significantly more pronounced (compared with controls) decrease of scales 1, 2, and 7 indicators, an increase of the SMPI scale 9 indicators, and a decrease of STAI and BDI indicators. The positive impact of autogenic training on the psychological status of the patients was mostly attributable to the reduction of anxiety, tension, fixation on negative sensations, and sensitivity to the stress factors as well as to the increased activity and the improved mood. The study of AT predictors revealed that the increase of scales 4 and 6 of SMPI and BDI indicators fairly well predicts the lack of the effectiveness of the method under consideration.

CONCLUSIONS

The beneficial influence of the autogenic training on the psychological status of the patients presenting with chronic somatic diseases is mainly mediated through the decrease of anxiety, tension, fixation on negative feelings, sensitivity to stressful influences, increased activity, and improved mood of the patients. A study of AT effectiveness predictors revealed that an increased level of rigidity reduces the effectiveness of this method because of the tendency of the patients toward making excessive efforts to achieve the state of relaxation. The predictors of the high effectiveness of AT the development of which requires regular training proved to be a moderate decrease of the psychological adaptation level together with such characteristics as the ability of the patients to control their behavior, purposefulness, and perseverance in achieving the goal.

摘要

背景

自生训练(AT)是治疗慢性躯体疾病(CSD)患者最广泛使用的心理治疗方法之一。多项研究表明,在自生训练的影响下,患者的心理状态有所改善。然而,迄今为止,治疗效果的潜在机制以及AT效果的预测因素仍未得到充分研究,这阻碍了该技术差异化适应症的发展。

目的

本研究的目的是评估AT的有效性,并确定慢性躯体疾病患者治疗结果的预测因素。

材料与方法

该研究纳入了325例CSD患者,使用简化多因素人格量表(SMPI)、斯皮尔伯格状态-特质焦虑量表(STAI)和贝克抑郁量表(BDI)进行检查。患者被随机分为两组。第1组(主要组)由163例接受基于AT的心理治疗的患者组成,第2组(对照组)由162例未接受心理治疗的患者组成。为了确定AT有效性的预测因素,在研究期结束时,主要组的患者被分为两个亚组:(a)包括128例心理状态在心理治疗后恢复正常的患者,(b)包括35例健康状况有所改善的患者。对每组患者的基线特征进行了比较分析。

结果

研究表明,在观察期结束时,主要组患者的量表1、2和7指标的下降明显更为显著(与对照组相比),SMPI量表9指标增加,STAI和BDI指标下降。自生训练对患者心理状态的积极影响主要归因于焦虑、紧张、对负面感觉的执着以及对应激因素的敏感性降低,以及活动增加和情绪改善。对AT预测因素的研究表明,SMPI量表4和6以及BDI指标的增加相当好地预测了所考虑方法的无效性。

结论

自生训练对慢性躯体疾病患者心理状态的有益影响主要通过降低患者的焦虑、紧张、对负面情绪的执着、对应激影响的敏感性、增加活动和改善情绪来介导。对AT有效性预测因素的研究表明,僵化程度的增加会降低该方法的有效性,因为患者倾向于过度努力以达到放松状态。AT高效性的预测因素被证明是心理适应水平的适度降低以及患者控制自己行为的能力、目的性和实现目标的毅力等特征,而这些预测因素的发展需要定期训练。

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