针对有身体意象困扰的头颈癌幸存者的简短认知行为治疗的潜在机制。
Mechanism underlying a brief cognitive behavioral treatment for head and neck cancer survivors with body image distress.
机构信息
Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
出版信息
Support Care Cancer. 2023 Dec 16;32(1):32. doi: 10.1007/s00520-023-08248-7.
PURPOSE
Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT.
METHODS
In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive five weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the Inventory to Measure and Assess imaGe disturbancE-Head and Neck (IMAGE-HN). Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores.
RESULTS
Among 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month resulted in decreases in IMAGE-HN scores from baseline to 3 months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3 months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039).
CONCLUSIONS
This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT03831100 .
目的
头颈部癌症（HNC）幸存者的身体意象困扰（BID）是一种与抑郁、焦虑、耻辱感和生活质量差相关的衰弱毒性。BRIGHT（Building a Renewed ImaGe after Head & neck cancer Treatment）是一种简短的认知行为疗法（CBT），可减少这些患者的 BID。本研究探讨了 BRIGHT 的作用机制。
方法
在这项随机临床试验中，患有临床显著 BID 的 HNC 幸存者被随机分配接受五周每周一次的心理学家主导的视频远程 CBT 会议（BRIGHT）或剂量和传递匹配的生存教育（对照[AC]）。使用身体意象应对策略量表（BICSI）评估身体意象应对策略，这是假设的中介。使用头颈部癌症相关的身体意象干扰量表（IMAGE-HN）测量 HNC 相关的 BID。使用因果中介分析估计 BICSI 评分变化对 IMAGE-HN 评分变化的中介效应。
结果
在 44 名有 BID 的 HNC 幸存者中，分配到 BRIGHT（n = 20）或 AC（n = 24）的患者中，中介分析显示，与 AC 相比，BRIGHT 降低了从基线到干预后 1 个月的回避身体意象应对（BICSI-回避量表评分的平均变化）（p = 0.039）。从基线到 1 个月，BICSI-回避评分的降低导致从基线到 3 个月 IMAGE-HN 评分的降低（p = 0.009）。BRIGHT 对 3 个月时 IMAGE-HN 评分的影响部分通过 BICSI-回避评分的降低来介导（p = 0.039）。
结论
这项随机试验提供了初步证据，表明 BRIGHT 通过减少回避身体意象应对来降低 HNC 幸存者的 BID。需要进一步的研究来证实这些结果，并增强针对相关途径的干预措施的开发，以减少 HNC 幸存者的 BID。
试验注册
ClinicalTrials.gov 标识符 NCT03831100。
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